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Nurse ratios to be published by trusts for first time

Nurse-to-bed ratios are to be published for every hospital in England under plans to monitor quality in the reformed NHS, Nursing Times has learnt.

A “quality dashboard” is currently being developed by the Department of Health, which is intended to act as a transparent measure of trust performance.

The dashboard will feature a range of information about trusts, including the number of registered nurses they have per bed. It will also include a doctor-to-bed ratio, staff and patient survey results and more traditional measures such as data on healthcare associated infections and mortality ratios.

Nursing Times understands trusts will be expected to update the information on their nurse-to-bed ratios at least every three months.

The inclusion of the workforce measure in the dashboard follows high profile debate about whether the government should set minimum staffing levels for hospital wards.

It is also one of the issues Mid Staffordshire Foundation Trust public inquiry chair Robert Francis said he would consider when producing his report, which is due in the autumn.

Work to develop the dashboard is being led by DH national director for quality Ian Cumming. He told Nursing Times the measure was intended to start a conversation and not be a “pass or fail” for trusts.

“The nurse-to-bed ratio is one of a number of workforce measures. What we’re not doing is passing any judgement about what’s the right level of nurses to patients,” he said.

In a session at last week’s NHS Confederation conference in Manchester, Mr Cumming told delegates that while compiling the quality dashboard, his team had found that the registered nurse to open bed ratio currently ranged from 1.1 to 2.4.

Both the Royal College of Nursing and Unison have been calling for the introduction of mandatory staffing levels.

Unison head of nursing Gail Adams told Nursing Times the dashboard measure represented progress. But she said it was weakened by using nurse-to-bed ratios, rather than nurse-to-patient ratios and for failing to take account of the acuity of patients.

RCN head of policy Howard Catton echoed her concerns. He said: “The nursing workforce is so critical to patient safety that it needs a set of high level metrics to tell you about the nursing workforce. That’s something we have been calling for and we welcome [the dashboard].

“However, there is a risk that [by] measuring the bed, you are not measuring the usage of that bed and you’re not saying anything about the dependency of patients.”

He also pointed out that the nurse-to-bed measure would not reflect caseloads outside the acute sector. The government is increasingly keen to see traditional hospital services provided in the community, despite evidence that district nurse numbers are falling. 

The dashboard is due to be published next month to allow organisations to get used to it and make any suggestions for improvement before it is rolled out fully next year.

  • The DH announced last week that Mr Cumming would be the first chief executive of Health Education England, the new body being set up to plan and oversee education and training for nurses and other health professionals.

Readers' comments (33)

  • Surely it would need breaking down into nurse to bed ratios in A & E, admissions unit, ICU, psychiatric, specialist units, palliative, surgical and then the poor old medical/care of elderly unit that gets all the bad press usually cos of lack of nurse and high patient dependancy.

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  • like the comment above, I cannot see how you can get a fair picture with all the different shifts and fluctuations in nurse presence, as well as different needs in the various departments.

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  • from Anonymous | 26-Jun-2012 8:44 am

    furthermore you sometimes get overstaffing on quiet wards even for a few hours or whole shifts so high ratio of nurses to empty beds?

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  • Feels like an average might be taken from units of 2:1 or even 2.5+:1 to 1:14+ in general wards. Must be much higher in the Community. Distinctions should be made btn different wards/units, acuity of patients, numbers of admissions, transfers + discharges - as a nurse involved with that cannot be effectively looking after other patients at the same time. Also I assume this will not account for skills, experience (grade) of nurses required for safe care and staffing levels on different shifts, eg nights + weekends/ Bank Holidays.
    Would be good to see doctor ratios (like nurses, how many juniors, seniors + consultants are available on different shifts) and staff + patients survey results in the same place too.

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  • hopefully after this is completed some positive action will be taken and it is not just another exercise of giving people a job to do and then leaving the report on their findings to gather dust with all the hundreds of other surveys and reports. it seems that by the time these are processed and published they are totally out of date and have to be begun all over again.

    i agree with andy that doctors ratios, and in fact the whole staffing right across the NHS, needs to be examined and dealt with appropriately according to the findings.

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  • From Australia
    FYI UK
    Please paste and read.

    This is from our ANF ( Union ) website.
    Lots of links, but there is so much already out there as to why NURSE TO PATIENT Ratios should become mandatory worldwide. This article above is just stating another form of action to try and prove what??? It has already been known for years.

    TRUSTS.....Of course the introduction of ratios is going to cost money, but DO THE RESEARCH and see where you actually save money and lives! Stop pussyfooting around and just get it started! This is all to do with money and not staff/ patient safety and also patients rights.

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  • I'm sure all the 'non-clinical' fannying about in the backroom shuffling paperwork clipboard practitioners will find themselves being factored into the ratio...

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  • michael stone

    I think this looks like a good idea, to me, before it gets screwed up somehow (asit probably will).

    As people have said above, you need enough figures, so that you can be sure you are meaningfully comparing like-with-like, and not apples with turnips.

    But very rarely do you seem to be presented with enough raw figures, which have not been 'manipulated during collection', partly perhaps because 'people cannot cope with numbers' - something which, sadly, seems to be disturbingly true !

    The CQC has apparently seen a huge increase - 10 or 20 times - in the numbers of 'whistleblowing/bad behaviour reports' since Winterbourne View: obviously 'the official figures' must have been pretty pointless, before that Panorama programme, but I have no doubt that people used to sagely point at them and say 'well, we have got the figures for this' !

    Counting, and statistical analyses, alone, are not enough to invariably extract meaningful information, for all problems. If the data is extensively analysed, but was rubbish in the first place, the conclusions are usually rubbish as well !

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  • Folks ,this has been an ongoing situation that will not be taken into consideration until some of these Trusts face more severe long standing litigations,then they will start to do tings differently.
    A lot of trusts is not speaking the truth when it comes to staffing levels.When there is a vacancy ie they tell their nurses that they put out shifts to agencies/bank but in London there arequite a significant number of nursing agencies and often times nurses are allowed to work on for eg 22 beds with tracheostomy ,confused patients and the numerous paper work is apalling .
    I notice in the trust where I work when there is inspection the managers tend to have full staff and on other days there is absolutely none.
    i think this needs to be addressed immediately.

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  • Somehow I feel that this may be used against us. Previous comments have already mentioned factors such as dependency/needs of patients in different clinical areas. In my trust this had led to a staff nurse being cut from the night duty as we were classed as being ''over staffed''. As an acute admission unit our needs change rapidly - when we were 'assessed' it was a reasonably quiet night - now with one qualified down we are all so stressed and overworked - with managers putting the emphasis on paperwork! As usual. They do not understand that sometimes sitting with a scared or confused patient is more important. Never mind the risk of reducing falls.
    Trusts are more concerned with cost cutting than paying for a nurse 'to waste time chatting with a patient', a comment I have heard too often lately.
    So I view this with suspicion!

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  • Nurse-to-bed ratios must be calculated using W.T.E. not headcount!

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  • -I vote for Nurse to patient ratio
    -I vote for appropriate scientific research
    -I vote for for proper Quality Control and
    assessment starting from base/shop floor
    and continuing to the top
    -I vote to stop wasting more time and
    NHS money doing rubbish research and

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  • Yet another exercise in tick box futility to demonstrate 'transparency' (whatever that particular buzz word means).

    Surely a committment by the service to patient care, safety and satisfaction would be better shown by an adequate provision of Nurses. Nurses observable and available to patients, their families and carers on all wards..... In fact, just like it used to be when hospitals were ran as a Health Service, not a business.

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  • Anonymous

    Roger Hodgson | 27-Jun-2012 8:51 am

    Well - yes.

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  • how much more money is going to be spent on this endless round of surveys, reports and audits. Just stop wasting money and get more staff on the wards, this is just another complete waste of time and energy.

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  • tinkerbell

    Roger Hodgson | 27-Jun-2012 8:51 am

    i too am fed up with this tiresome overuse of the word 'transparency'. Think it use to mean 'honesty' in good old fashioned plain english. But who knows anymore? Maybe it has something to do with cling film nowadays. Who knows.

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  • Am I alone in wondering who will be compiling these figures? Another task for the nursing staff? And at what time of day will they be compiled - at shift change over there will be a larger staff/pt ratio, but only for about 90 minutes...

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  • There is a myth that you don't need as many staff on at weekends or bank holidays because the ward is 'quiet'. Usually the opposite is true.

    Yes okay you don't get so many ward rounds, or procedures but patients who become acutely unwell are very reliant on the nursing staff as there are not so many doctors available. This is when you need your experienced nurses on duty.

    Patients deserve better, nurses deserve better. When something gets missed it is the individual nurses fault apparently, nothing to do with staffing numbers or skill mix.

    Why can't these pen pushers come and work on a ward, look after 12 patients by themselves and see what really goes on before they write up their reports.

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  • I wouldn't trust the figures they'll give. They will lie.

    They will have to lie. What's the point in being truthfull? That would just mean more money would have to be spent.....and they ain't going to do that. So prepare to be lied to.

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  • Anonymous 28-Jun-2012 9:33am

    Yes we do need the pen pushers to come and do our shift to see how it really is but it won't happen. If they do come on the ward it is just observing and as we all know you have to do and be responsible for to understand.
    Weekend and bank holidays are a challenge, one doc covering several wards, many unhappy relatives, stressed staff nurses.
    Would more staff nurses help to share the load 'Yes'.

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