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Mid Staffs inquiry considers minimum staffing levels

Minimum staffing levels do not necessarily improve patient outcomes, the Mid Staffordshire Public Inquiry has heard.

During a seminar focusing on nursing, the inquiry considered whether minimum staffing levels should be introduced in the UK. It was attended by more than 20 of England’s most experienced nurse directors.

The seminar, which is one of seven being held to inform the inquiry’s final recommendations, heard evidence from California where minimum nurse to patient ratios were intorduced in 2004.

A research paper, presented by Leeds University professor of applied health research Dawn Dowding, found no apparent difference in outcomes between California and other states that did not have minimum staffing levels.

Professor Dowding said research showed the number of registered nurses as a proportion of the workforce appeared to have a bigger impact than just increasing numbers of nursing staff.

The seminar also heard that the average number of patients per registered nurse in the UK had increased from 6.9 to 8.4 between 2007 and 2011.

Elaine Inglesby, executive nurse director at Salford Royal Foundation Trust, told the inquiry she had set minimum staffing levels in her trust to make sure they remained safe if it was faced with a “third or fourth year” in a row of having to make savings. But she said she was anxious for new nurse executives who may not have the experience or confidence to make those judgements.

In her evidence to the public inquiry, former Mid Staffs nursing director Helen Moss said she had not known where to go for guidance on staffing levels when she was confronted with a ratio of registered to unregistered staff as low as 40:60 in some wards. Mid Staffs had been her first board level role.

Some nursing directors criticised the Care Quality Commission’s claim in its hospital dignity and nutrition report last month that staffing levels were not a determinant of poor care.

Jenny Leggott, deputy chief executive and nursing director Nottingham University Hospitals Trust, said the CQC’s judgements on staffing levels were based on comments from individual staff members rather than clear evidence.

Current Mid Staffs director of nursing Colin Ovington told the seminar that numbers alone would not ensure good care if a high proportion were temporary agency staff.

“You should be able to expect a standard of care from these individuals, in my experience you generally can’t. I have referred eight [agency nurses] to the Nursing and Midwifery Council. The more temporary staff you have in your workforce the greater variability,” he said.

Concluding the seminar, inquiry chair Robert Francis said those present were the “great and the good” of the nursing world who could “turn around” other struggling organisations.

“It’s people like yourselves who can do far more about poor care than any report I write or any action by the secretary of state,” he said.

Readers' comments (15)

  • michael stone

    Oh, for heaven's sake - this question depends on where the minimum staffing ratio is set, for any given working enviroment !

    At some critical point, 'X' staff will be working at full stretch, and reducing the number below X simply must have an adverse effect ! But if he was comparing ratios of (for example) 1:8 and 1:10, when that critical point were 1:14, he might well find that the staff ratios were not a dominant factor !

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  • Of course minimum staffing levels should be introduced into the UK! The issue is past bloody debating! The clinical evidence is vast on this topic and is being used in other countries such as Australia, America, etc.

    We need a ratio of 1:4 - 8 dependent on area! And that ratio is for QUALIFIED staff, not just any staff!!!!!

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  • This is riduculas it is even being question after all the research and ancedotal evidence that is out there.

    Everyone, please please sign this petition I have found and spread the word for more to sign.

    http://epetitions.direct.gov.uk/petitions/19157

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  • ridiculous I meant to spell.

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  • I work on a busy atroke ward, which is supposed to be for rehabilitation.. They say we can have 5 staff on an early 4 on a late and four on a night. for 22 dependant patients, alot of these patients need all care,,,, We know have more paperwork to fill in, which takes us away from patient care!!!!!! relatives to attend to as well as the patients. There is simply not enough hours in the day and the people at the top do not seem to listen to the staff on the shop floor!!!! figures look good on paper, but dont work in real life!!!! I am not a shirker and give my all!!! It just upsets me that they are setting us an impossible task. Its like they want us to fail!!!!! They need to look at the dependancy of patients, not how many we have in a bed!!!!!!!

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  • This is all just manipulating figures again.
    New Figures please with figures for
    1. ITU / HDU, Admissions and A&E areas excluded
    2.any nurse who is not directly involved in patient care excluded
    3. specialist nurses excluded because these give advice and not patient care

    When mostly they quote ratios of qualified nurses to patients they often include ward managers who are for the most part not involved in patient care and critical and emergency care where ratios are much better. ITU 1:1 etc This hugely skews the figures and makes the ratios seem far better than the reality of the everyday experience of patients
    Our teaching hospital trust is mostly 1 : 12
    Or simply quote us the mode average not mean average.

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  • tinkerbell

    Anonymous | 2-Nov-2011 12:53 pm
    signed.


    Anonymous | 2-Nov-2011 12:57
    exactly.

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  • Anonymous | 2-Nov-2011 12:57 pm

    You have painted such an accurate picture of the reality of work for many Nurses.

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  • Anonymous | 2-Nov-2011 12:53 pm already signed that one.

    Agree with all of the above. The fact that they continue to come out with bull**it like this is an insult to us all.

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  • MINIMUM STAFFING LEVELS CAN SURELY BE WORKED OUT BY ONE THE MANY INDEPENDENT COMPANIES BEING BROUGHT IN TO WATCH OVER NURSES AND DOCTORS DAILY.
    AS THESE PEOPLE STAND AROUND WATCHING AND MAKING NOTES LETS HOPE SOME GOOD OUT OF ALL THIS TO RELIEVE THE PRESSURE OFF THE MEDICAL AND NURSING STAFF BEING EXPECTED TO GIVE CARE AT THE SAME TIME AS TICKING THE EVER INCREASING NUMBER OF BOXES/TARGETS/TIMES ETC..
    THE ONLY PROBLEM WILL BE IS WHEN THE NHS REALISE THE MINIMUM STAFFING LEVELS IN ACUTE AREAS WILL MEAN MORE STAFF TO BE EMPLYED AND THAT WILL NIT BE IN THE BUDGET!

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  • Hello, I just wanted to say not all specialist nurses "only give advice" as a previous comment suggests.

    My role involves assessing, diagnosing and treating, issuing prescriptions or drugs from stock, answering and triaging telephone calls to ensure patients are signposted to timely assessment and treatment. It is not uncommon to see 20 (and sometimes more) patients during a day plus the above work - so my ratio is 1:20 and therefore I feel adds more weight to the staffing requirements argument.

    Perhaps an audit of what has not been done at the end of shifts is in order to demonstrate the holes in care delivery - may wake a few beaurocrates up??

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  • I have taken to sending my manager a weekly email of the tasks I have not completed for that week because of the workload. Certainly simple ratios do not give the true picture. Evidently (sic) we have good ratios of Nursing Staff to Patients and Qualified to Unqualified but even working unpaid extra time and as efficiently as I possibly can do not have time to complete all that we should. This is due to the needs of the patients and the numbers of temporary and bank staff. I find that I have to prioritise patient and staff safety each shift and even have to tell staff to have a drink as they are so busy looking after the needs of the patients.

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  • I agree with all the above comments and feel minimum staffing ratios are needed.

    However, this also needs to be considered against the skill mix. I have been qualified for about a year/ 18 months and on 90% of my shifts I am nurse in charge working alongside more junior team members/ bank/ agency staff etc..

    I accept that there are times of long term sick/ maternity leave/ people leaving etc...
    which make this more prevalent but its a joke when you walk in for handover to find you are the only person on duty who works permanently on the ward.

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  • When I was in nurse management back in the 80's/90's. We used a computer programme that fed in all aspects of skill mix and predicted patient dependency for the following day.

    This was carried out by ward staff and fed in to the programme by nurse managers. It had a two fold purpose.

    Not only did it provide the right amount of numbers of staff and skill mix to provide good care but it also furnished us with a powerful argument to maintain or increase our nursing establishment.

    I cannot believe that 2 decades on, and with all the relevent evidence over that time, we do not have anything in place.

    Appauling.

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  • Hi
    Sorry I have come to this discussion a bit late. Could you please share the details of the computer programme that you used, is it still being used? Thanks

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