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Francis report: NICE should draw up safe staffing levels

Minimum safe staffing levels should be drawn up by the National Institute for Clinical Excellence and policed by the Care Quality Commission, according to the Francis report.

The Mid Staffordshire Foundation Trust public inquiry report, written by Robert Francis QC, was published today.

It recommended that NICE develops “evidence-based tools for establishing the staffing needs of each service” in the NHS, which it is “likely to require as a minimum in terms of staff numbers and skill mix. This should include nursing staff on wards, as well as clinical staff”.

“These tools should be created after appropriate input from specialties, professional organisations, and patient and public representatives, and consideration of the benefits and value for money of possible staff: patient ratios,” the report said.

It said they should act as a practical means of measuring compliance with “fundamental standards” that should be policed by the CQC.  

“These measures need to be readily understood and accepted by the public and healthcare professionals,” the report said.

“Adoption of these practices, or at least their equivalent, is likely to help ensure patients’ safety,” it added.

The report noted that where NICE was unable to produce relevant procedures, metrics or guidance, the CQC should seek assistance from the royal colleges or other appropriate organisations.

The recommendation from Mr Francis follows the results of a Nursing Times survey, revealed on Sunday, which found more than half of nurses believe their ward or unit is dangerously understaffed.

The Royal College of Nursing, Unison and other groups have consistently backed the introduction of minimum staffing levels. They are already used in some states in the US and other countries.

However, the Department of Health has previously been reluctant to support a move towards nationally set staffing levels.

The national nursing strategy, Compassion in Practice, published at the end of last year by the new NHS Commissioning Board called for the use of locally set evidence-based tools on staffing.

Readers' comments (8)

  • Well, it's not before time that we had MINIMUM staffing levels. Time and time again we have staffing reviews aka 'lets cut numbers and dilute skill mix, again' How can you run a respiratory HDU with one trained nurse???
    Until we get the staffing numbers and skill mix right, we will continue to have wards dangerously understaffed. Quality and safety do suffer and now we have it in black and white from Francis. Lets hope all his recommendations come to fruition. Lets get nursing by the scruff of the neck and clean up our practice and try to earn the respect back of the victims families in Mid Staffs.

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  • I think we need guidelines for minimum staffing levels from agencies outside of hospital/community, etc. so that management in individual organisations can't do there own thing and get away with it.

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  • A minimum staffing number + skill mix will be a good start with a multiplier for increased acuity.

    It's difficult to properly meet patients' feeding + drinking needs, when it can take 30 mins to proper feed a person who is hungry but a slow eater and maybe a little disorientated or confused. Then there are regular bed turns to reduce risk of pressure ulcers; minimum of 2 staff needed + have seen 5 in exceptional instances, for a 'simple turn'. Even more difficult when you're in community work.

    The bottom line is money. But how much do we, as a society, value each life and improving the quality of lives?
    If its low there will be more preventable deaths. While directors + shareholders keep their profits.

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  • andy | 7-Feb-2013 4:55 pm

    whether personal budgets or the budget of the nation, it always amazes me how little people are prepared to invest in their health compared with all their material wealth, much of which is superfluous to needs and quickly discarded.

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  • I think community nursing is at more risk than ward nursing. In a ward settings where there are thirty-two or less beds once they are full they are full. In the community where the government want patients to be nursed closer to home with unsafe discharges why do they expect nurses to cope where there are no nurses to work in the communty and where you have the nurses the junior nurses do as they like not respecting their team leaders who usually worked very hard to meet patients' need. I think that the government need to do something towards the staffing level and stop putting patientsare risk by saving money.

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  • It sounds brilliant community care, that's why the government is pushing for it. The poor nurse, instead of going around a ward, now drives around her patch (increasingly at her own expense), and spending next to no time with each patient on her caseload. May have to assess, evaluate and solve challenges fast, as there isn't much support quickly available if need out there.

    Yes, a lot of problems could be reduced if we invested in our own health. Living longer isn't any good when you're suffering a few chronic problems for decades.
    Also as we get older, chances of getting shipped off into funny farms, sorry I meant older people (nursing) homes, increases as our family can't look after us; and paid for by our own taxes. You might get help with the communal valet to meet your needs (which our taxes paid for that too).

    Maybe its time to scrap the NHS.
    If we all paid for the services we need, other than being broke, we're more likely to try to stay healthier + fitter. We wouldn't end up feeling that our society is undergoing reverse evolution.

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  • ok let us talk about a night shift on a older person ward of mixed sex , 28 patient's a great many confused and anxious and some patients's needing acute clinical nursing skill. and the number of staff 2 reg nurses and 2 H.C.A. For God sake how can this be deemed safe practice by mangement. This culture needs to change for the safety of all our patient's.

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  • The Francis Report seems to have missed the point. NICE does need to establish guidelines to determine minimum staffing levels, but these will be treated as aspirational, not compulsory, and the CQC is not capable of 'policing' anything because it has no powers of enforcement.

    In manufacturing industry it would be a criminal offence, under H&S law, to allow a large piece of machinery to be operated without the correct number of staff. Can't we learn something from other sectors?

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