England’s chief nursing officer Jane Cummings has said it is now much harder for an NHS hospital to “hide” poor staffing on the scale seen at Mid Staffordshire Foundation Trust, while also highlighting the Nursing Times Speak Out Safely campaign.
Speaking after the publication today of Professor Don Berwick report into NHS patient safety, Ms Cumming said it was important trusts had the appropriate staffing level on their wards but called on staff to raise concerns where it was not.
She said staffing would be monitored by the Care Quality Commission’s new chief hospital inspector Sir Mike Richards. As previously reported by Nursing Times, staffing levels will not be used routinely to trigger inspections but CQC inspectors will check them during visits.
“We are in a completely different place to where we were with Mid Staffs. We have moved on and the new model of [CQC] inspection will look at staffing,” she told Nursing Times. “It is much less likely that they [a hospital] would be able to hide it now.”
However, she acknowledged that under the new CQC model the level of inspection was “not going to go into every ward or trust”.
She highlighted the importance of our Speak Out Safely campaign, which is calling for nurses to be able to raise legitimate concerns without fear of reprisal or blame.
Ms Cummings said: “This is everybody’s responsibility to support staff to speak out safely and the Nursing Times’ campaign is a strong example of that.
“We need to support all staff to be open, transparent and to raise concerns,” she said.
But she reaffirmed the government and NHS England’s opposition to a centrally-set minimum staffing level for hospital wards, despite ongoing pressure from unions and patient groups.
In his report, Professor Berwick had backed the use of “evidence-based acuity tools and scientific principles” to determine safe staffing needs, and that the National Institute for Health and Care Excellence develop guidance “as soon as possible”.
Although the report stepped back from calling for a mandatory minimum, it did cite “recent work” suggesting that “operating a general medical-surgical hospital ward with fewer than one registered nurse per eight patients, plus the nurse in charge, may increase safety risks substantially”.
“This ratio is by no means to be interpreted as an ideal or sufficient standard. We cite this as only one example of scientifically grounded evidence on staffing that leaders have a duty to understand and consider when they take actions adapted to their local context,” the report stated.
In February, Robert Francis QC’s Mid Staffordshire Foundation Trust public inquiry report called for specialty specific staffing levels to be drawn up by NICE.
Mr Francis has subsequently called for a rethink on the importance of minimum staffing levels, suggesting they should act as a safety “alarm bell”, as revealed by Nursing Times this week.
However, Ms Cummings said setting a minimum number was the wrong approach, because the level of staff needed would repeatedly change.
Using a ratio such as one nurse to eight patients – as called for by the Safer Staffing Alliance – “risks people just ticking the box” and could encourages the use of temporary or unskilled staff to meet the set level, she said.
She added that a requirement on trusts to use evidence based tools was part of the new national nursing strategy, Compassion in Practice.
The Berwick report also called for a new criminal offence for “wilful or reckless neglect”, which could apply to senior managers, including directors of nursing if they met the criteria.
Ms Cummings told Nursing Times the report made a clear distinction between people who made a mistake or error, and those who were wilfully reckless in their behaviour.
“That’s a very different place to where we were a few months ago. In the vast majority of cases there are already systems in place to address problems,” she said.
Ms Cummings said it was “absolutely” right for people to be held to account for “wilful or reckless neglect”.
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