Hospitals urged to follow Salford's staffing lead
All hospital trusts should publish staffing levels on every ward on a daily basis, an influential group of MPs has recommended.
In a report published today, the Commons’ health committee concluded the government’s current proposal to ensure safe staffing in English hospitals would not work.
The government plans involves “periodic inspection” by the Care Quality Commission and a requirement for trust boards to publish staffing levels twice a year.
Instead, the influential committee of MPs has proposed that commissioners should require daily publication and sharing of staffing information by healthcare providers.
The committee’s report – After Francis: making a difference – calls on all providers of NHS funded care to adopt the system used by Salford Royal Foundation Trust.
Salford Royal calculates staffing using a triangulated approach involving a workforce tool, benchmarking with other organisations and discussion between senior nurses.
It then publishes a “staffing board” on every ward, which is updated daily with the name of the sister or charge nurse, the number of patients, how many nursing staff there are and how many nursing staff there should be.
In June and July the trust conducted an acuity audit where staff collected data on the dependency of patients at the same points every day over a three week period. The results were fed into the Association of UK University Hospitals Acuity and Dependency Tool to help determine appropriate staffing levels.
The trust plans to repeat the audit twice annually and is aiming to have the correct numbers and skill mix on its wards 95% of the time.
Committee chair Stephen Dorrell said Salford’s approach was an “application of the principle of openness” in practice and benefited from not being a “formula developed in Whitehall”.
He told Nursing Times he did not think there was a need to insist trusts used the same tool as Salford but should be able to demonstrate the tool they did use was “robust”.
The committee examined the recommendations of Robert Francis QC’s report into the high profile care failings at Mid Staffordshire Foundation Trust and the government’s initial response to it earlier this year. Ministers are due to publish their full response to the Francis recommendations over the autumn.
As well as the government’s staffing proposals, the MPs’ report also criticised ministers for handing responsibility for the National Reporting and Learning Service to NHS England.
The service, which collects data on patient safety incidents across the NHS, was part of the National Patient Safety Agency until it was abolished in 2012.
The report said this gave the “impression… that the overall significance of patient safety policy has been downgraded”. It called for responsibility to be given to the CQC.
MPs did back government plans for a breach of fundamental care standards to be a criminal offence, but urged the government to consider whether it could be done through existing legislation without creating a new law.
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “The RCN has called for action to ensure there are safe staffing levels in all health care settings, and the committee highlights the importance of this.
“Indeed, there is a growing body of evidence demonstrating how crucial staff-patient ratios are to patient outcomes and this is supported not only by the report of Robert Francis QC but also by the findings of Sir Bruce Keogh and Professor Don Berwick.”
He added: “The committee has produced a useful review of what is needed and how it can be achieved, and we now look forward to the government’s full response [to the Francis report] in due course.”
Sally Brearley, chair of the Prime Minister’s Forum on Nursing and Care Quality, told Nursing Times the forum welcomed the committee’s recommendation that trusts publish their staffing levels on the wards, but would have like to see them go further.
“The committee highlighted the government’s view that there must be local freedoms on staffing,” she said. “Absolutely people need freedom as long as it doesn’t conflict with the patients’ freedom from harm.
“Trusts can be free to go above one to eight but we would be very concerned if they were going below.”
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