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Ward ratio of 60:40 is low as you can go, CNO tells Mid Staffs inquiry

England’s chief nursing officer has admitted the NHS is at a time of “heightened risk” due to the twin challenges of reorganisation and the need to make £20b of efficiency savings by 2015.

Giving evidence to the Mid Staffordshire Foundation Trust public inquiry, Dame Christine Beasley said she doubted a similar situation – where the trust was short of 120 nurses after slashing £10m from its budget – would happen today.

“The refrain [around the NHS] is often: Are we sure we’re not in a Mid Staffs situation,” she said.

Dame Christine suggested the Care Quality Commission could look at what processes organisations had in place for determining and monitoring there staffing levels as part of its licensing process but rejected calls for statutory guidance on staff numbers and skill mix.

She conceded that a 60:40 registered to unregistered was as low as you should go in an acute hospital ward but said her “concern” with mandating minimum staffing levels from the DH was that “instead of becoming the floor they become the ceiling.

She criticised former Mid Staffs nursing director Helen Moss, who arrived at the trust to find skill mix as low as 40 registered to 60 unregistered on some wards, telling the inquiry she couldn’t think of any circumstance where that skill mix “would be acceptable”.

Asked if she shared concerns expressed by Nursing and Midwifery Council chief executive Dickon Weir-Hughes at an earlier hearing that the abolition of strategic health authorities would lead to a loss of professional support for nurses she said she did.

England’s 10 SHAs are in the process of clustering to form four organisations.

Dame Christine said: “We are still keeping an SHA role but covering much bigger areas. I have lived through so many changes of that sort of level and what nursing is very, very good at is that they a very strongly networked profession and in my experience when the changes happen they regroup around whatever the structure is.”

Dame Christine is one of a number of high profile figures appearing before the Mid Staffordshire Foundation Trust public inquiry this month.

Live coverage is available to subscribers of Nursing Times’ sister title HSJ

Readers' comments (10)

  • Christine Beasley. USELESS! USELESS! USELESS! Your exit from your post cannot come soon enough!!

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  • Dame Beasley has in 2 short sentences completely contradicted herself! Of course we need a mandatory minimum staffing level to ensure patients' safety and ensure that more nurses don't leave the "profession". Where I work (non acute) we have 1 qualified nurse to 5 carers.

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  • Watch the words:
    "60:40 registered to unregistered"

    Not qualified to unqualified. Now with the assistant practitioners that are now being produced from the unregistered workforce (who will in all probability be de facto enrolled nurses) will also probably be the vanguard of registered care support workers. That will mean the 60 of the 60:40 split could potentially be composed of RNs and assistant practitioners. You'd have thought the CNO would have a bit more about her wouldn't you?

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  • This woman is a fool and an embarassment to our profession, the sooner she is out the better! Stop clinging onto the post by your fingertips and just go!

    We NEED a LEGALISED Nurse patient ratio of at least 1 Staff Nurse to say 6 - 8 patients, we NEED a skill mix that ensures enough QUALIFIED staff are there to enable us to do our jobs safely, and there is enough unqualified staff there to back us up! 60:40 is not enough!

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  • Our registered nurse levels increased recently from 1 RCN to 10 patients to 1 RCN to 8 patients BUT they took away HCA's posts, so the benefits to a certain extent were lost as answering buzzers washing/dressing did not realease us to do our other tasks eg PAPERWORK, social etc also trying to do drug rounds whilst toileting patients I am sure you understand what I mean.

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  • Anonymous | 11-Sep-2011 0:09 am

    where's your tabard?


    From you post, I understand that your managers do not understand logic or health economics. Although I am not aware of the full picture, I do not understand their rationale behind this move!

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  • perhaps tabards with the message could be used at all times and cut down radically on the number of RNs required! They could be removed during patient care and quickly donned when the managers are in sight - "please do not disturb, paperwork in progress"

    tongue in cheek, having written endless blogs on the objections to the use of tabards, some ridiculous, and taken up Christina Odone's derrogatory articles on the nursing profession with the DT.

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  • 11- Sep-2011 - 0.09am

    As an update to my previous post. I feel if Trusts can say there is one RN to 8 patients it looks good on paper because it is not usually mentioned how many HCW are on duty. As to wearing a red tabard doing drug rounds how do you pass the task on when the other HCW are busy, the buzzers are all lit up and the patients want the toilet and are in distress. Also most elderly medical patients would not understand them anyway.

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  • Anonymous | 11-Sep-2011 9:54 am

    I was only joking about the tabards? no disrepect meant. Perhaps you haven't followed all the recent press about them in NT and DT?

    They obviously work very well in some units and maybe not in others. All I object to is the way a woman from Patient Concern reacted when measures are being taken to ensure patient safety and which was followed by an angry and senseless backlash from Christina Odone of the DT in articles about the nursing profession of which she demonstrates clearly that she knows very little about.

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  • Anonymous | 9-Sep-2011 11:48 am

    For information only: People seem to forget, or don't know, that SEN training was a Registered Nursing course, the same register (GNC?UKCC?NMC) as SRN/RGN/RNs, etc., etc. with a PIN number!

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