Frontline nurses should be “empowered” to raise concerns over short staffing and be protected when they do, the chair of the Mid Staffordshire Foundation Trust public inquiry has told MPs.
Appearing before the Health Select Committee today, Robert Francis QC spelt out his ideas for new minimum staffing tools for individual clinical areas and how a legally-binding duty of candour would help nurses working on wards to speak out.
Both are among 290 recommendations in his seminal report published last week.
He told the committee that nurses should not be put in situations where they were faced with having to prioritise care due to lack of staff. But if they did find themselves in such a situation, they should be empowered to pass on their concerns, he said.
“[In] a circumstance where a nurse comes on duty and discovers there are two nurses and 30 patients – all in desperate need – and clearly she has to prioritise what she does… What she must do, and is under a duty to do, is to inform her manager that this can’t possibly go on.
“I want to ensure those who are professionally responsible on the frontline are not just left with nothing to do, I wish to see them empowered to express a view and by doing that they are defending their own position,” he told the MPs.
“Let’s use that defensiveness to ensure the responsibility gets to where it should be where someone is capable to do something about it,” he added.
The barrister, who led the probe into Mid Staffordshire Foundation Trust, said the increased transparency and accountability should be backed up by new minimum staffing tools developed by the National Institute for Health and Clinical Excellence.
These should cover both the ratio of staff to patients and the skill mix between registered and non-registered staff.
The tools would provide “evidence based guidance” to trusts, so they knew whether they had enough nurses to “provide safe and proper care in an individual clinical setting”, Mr Francis said.
MPs asked why he had not recommended a general minimum staffing ratio. For example, the Royal College of Nursing said in 2006 that skill mix should not fall below 65 registered nurses to 35 healthcare assistants.
But Mr Francis said: “It is difficult and probably not helpful to have overall staff ratios because circumstances change on a day-to-day basis.”
He also told the committee there was a lack of accountability throughout the NHS. “By that I mean anyone from a sister running the ward to the head of the NHS and secretary of state,” he said.
Everybody in the NHS should be “personally responsible for their actions and have to reflect on that”, he said.