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.