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Minister claims nurse staffing ratios 'not the answer'

Health minister Dan Poulter has appeared to rule out the introduction of nationally recognised minimum nurse staffing levels, despite them being recommended by the Francis report.

Speaking at a conference organised by health think tank the King’s Fund in response to the Mid Staffordshire Foundation Trust Public Inquiry report, Dr Poulter said he had “not seen the evidence” to support the inquiry’s recommendation.

The report proposed that the National Institute for Health and Clinical Excellence develop nationally recognised minimum nurse staffing levels for a range of different settings. The recommendation was strongly supported by Unison and the Royal College of Nursing.

But Dr Poulter said: “Sometimes when you put in mandatory standards you can have a drive to the bottom… I don’t think staffing ratios is the answer.”

Nursing Times understands the government favours the approach set out by the chief nursing officer for England’s new national strategy Compassion in Practice, which was launched at the end of last year. This calls for existing tools for calculating appropriate staffing levels to be refined to support local determination by nursing directors.

Dr Poulter also told the conference the government’s formal response to the report, due at the end of March, would not involve a detailed consideration of each of the 290 recommendations.

He said: “Our response will focus on common themes rather than be line by line on every one of the recommendations. It will reflect the impact of culture, a greater focus on quality, greater clinical input into policy making and a greater attention to the needs of patients.

Dr Poulter also appeared to suggest that the report was a vindication of the government’s reform of the NHS.

“It’s clear from this report that patient care and safety has suffered… It’s also clear that the system needed to be restructured to put patient safety at the heart [of the NHS],” he said.

The junior minister was asked by Oxford University Hospitals Trust chief executive Sir Jonathan Michael how trusts should handle the sometimes competing pressures to provide quality care, meet performance targets and balance the books.

Dr Poulter, who has continued to work as a doctor since being elected as an MP in 2010, said improved integration with better partnerships between primary and secondary care could help reduce some of these pressures.

However, he insisted there was never an excuse for the failures of care described in the Francis report. “There should be no one trying to make excuses for that,” he said.

Meanwhile, the Scottish government announced this week that a workload measurement and planning tool for determining “appropriate” community nursing levels and skill mix would be available to all health boards from May.

Scottish health secretary Alex Neil said: “The community nursing workload assessment tool has been developed in partnership with community practitioners – district nurses, public health nurses, health visitors and school nurses – to ensure it reflects the needs of community working.”

The tool looks at the number of patients, the complexity of the care provided by community nurses, time required for and mode of travel, and also factors in additional time for unexpected disruptions, or tasks such as administration. 

Readers' comments (47)

  • Dr Poultice is obviously a card carrying member of the idiot party....Good bye NHS in the hands of these hell-bent on privatising healthcare/kick the nurses fascists.
    yours truly
    Amazed of everywhere

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  • what does he know he is a doctor

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  • Anonymous | 28-Feb-2013 1:26 pm

    what a senseless comment!

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  • Ideology has triumphed over logic. Well, is there anyone who believes the issues of the NHS are going to be addressed now? I think all reasonable, logical argument has been exhausted. We either fight like crazy, now, or we walk away. There really is no alternative on offer. If we stay the present course conditions will become exceedingly worse. Nurses will be the ones left carrying the can. we will be digging our own professions grave by not fighting. To do nothing, to allow Poulter et al to have their way will leave a toxic legacy for nursing.

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  • Anonymous | 28-Feb-2013 2:00 pm

    creation of a new streamlined and up to date health service which cares for its patients - you might be pleasantly surprised.

    all these obstructive thoughts, behaviour and comments are getting very tedious.

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  • what is needed is innovation!

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  • One might be pleasantly surprised with a streamlined health service, especially an innovative one. One might also presume listening to the considered advice from an inquiry into the failings of a health service, might achieve the above streamlining safely.

    It might be tedious to some, especially those who wish to ignore recommendations from an inquiry. That takes a closed mind, usually you have an existing agenda. And therefore nothing is going to change you. We can only base our beliefs, knowledge etc on our experiences. To date, and I'm going back 20 years, government ideology has been a disaster for the service. I'm not pro labour or Tory, just pro NHS.

    One thing is certain, when it all goes bad we nurses will be the ones to be compared to Myra Hindly or nazis, not Poulter.

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  • I am concerned over the fact that the government want to publish a report on the themes in response to the Francis report. This is a very good way of ignoring the little details that are very important because they can generalise instead. A brilliant government strategy which can cause extreme problems for the NHS and basically ignore safety issues in the report

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  • Anonymous | 28-Feb-2013 3:12 pm

    I would suggest that it is those who oppose any form of change or even suggestions for improvement, such as the recommendations in the Francis Report and the government reforms, that are the ones who have closed minds.

    How about putting patients and the economy at the centre of the arguments for a change and some answers to how to provide care for them may emerge. Solutions may not be about more staff, (this needs to be adequately researched and not just based on hearsay), but more to do with social conscience and figuring out reasonable courses of action whist the country is in the middle of an economic slump!

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  • michael stone

    Robert Francis seems to be a man after my own heart - accordign to today's Times:

    Mr Francis told a conference at the King's Fund think-tank that the NHS must start improving its culture immediately. "There is much in this report that doesn't require a change of law, it doesn't require a policy guidance from the Care Quality Commission. It doesn't require anything other than a change of attitude on the part of people."
    He said that the "first and foremost" thing that healthcare workers could do was to listen to those who had complaints because "there is almost always something you can do about it".

    Francis is not readily going to accept 'corruption and cherry-picking' of his report, so far as I can discern from his comments in various places.

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  • What streamlining? What innovation? What does this mean? Hard facts please. Not woolly fudging. Tell us all just how you are going to improve patient care in the context of Dan Poulter's comments.

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  • The tight fisted git doesn't want to pay for them that's why.

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  • The tight fisted git doesn't want to pay for them that's why.

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  • tinkerbell

    Dr Poulter said he had “not seen the evidence” to support the inquiry’s recommendation


    Well get on the wards then Dr Poulter.
    they are fact for most frontline NHS nurses.

    It's no better in the private nursing homes that i visit daily either as a community nurse on secondment from NHS ward. I visit over 16 private sector residential, EMI and nursing care homes.

    Staff turnover in the private care homes is horrendous and there is a lack of continuity of care in most of the homes as no one stays long enough to get to know them.

    From one month to the next they have different managers because the last one left from the exhaustion, same for the HCW's and staff nurses.

    So much for the private sector.

    This government will do exactly as they like regardless of what nurses are experiencing because you cannot reason with an ideology.

    The situation will get worse with the ageing population placing greater demand on limited NHS resources.

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  • You are getting desperate, Dan.

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  • Anonymous | 28-Feb-2013 3:33 pm

    "Solutions may not be about more staff, (this needs to be adequately researched and not just based on hearsay)....."

    Plenty of research is available. Perhaps it would suit your 'closed mind' to pass it off as hearsay.


    http://www.rcn.org.uk/__data/assets/pdf_file/0009/476379/004280.pdf

    http://www.bmj.com/content/344/bmj.e1717

    https://www.kcl.ac.uk/nursing/research/nnru/publications/Reports/RN4Cast-Nurse-survey-report-27-6-12-FINAL.pdf



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  • Anonymous | 28-Feb-2013 5:34 pm

    haven't the NHS reforms and the Francis Report provided you with enough facts to work on?

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  • Dr Dan continues to work as a doctor-so is he a part-time doctor or MP? As for not seeing the evidence well theres a surprise -how long have you been qualified Dr D.? And of course shock horror our Chief Nursey agrees with the government and not with the recommendations-so its just carry on as usual-

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  • So the ability to bkuff his way through the devious machinations of Westminster and claim untold amounts of expenses qualifies this crass oaf to dictate safe Nurse/patient ratios....

    God preserve the NHS from the clueless intervention of overqualified simpletons.

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  • People have to hang on to their jobs, once they are near the top of the slippery slope; which is why the government's views will prevail for the next 2 years.

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