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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.”

Are you able to Speak Out Safely? Sign our petition to put pressure on your trust to support an open and transparent NHS.

 

Discussion

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We’ll be holding a twitter discussion at 1pm on Wednesday18 September. Let us know your views using #NTtwitchat

Readers' comments (36)

  • "how many nursing staff there should be"

    According to what evidence based calculation (given that you appear to be able to use whichever tool you fancy)? According to what criteria?

    1:8 is the current 'plucked out of the air' figure that many nurses know is simply not enough staff. If poor care exists where there is a published staff/patient ratio of 1:8, I guarantee that the blame will shift to the nurses being inefficient, incompetent, etc, not the fact that 1:8 is clearly not enough or that whichever tool in use, is not evidence based and/or effective. What about skill mix?

    Once again, a group of unqualified MPs have issued their latest ill thought out stunt to appease the public. Listen to the evidence. Listen to Nurses.

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  • I would phone a national newspaper and report any concern before I would ever speak to a 'cultural ambassador' (flunky) or anyone else in my Trust. At least something would get done. Job be damned.

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  • they need to look at the skillmix and experience too,there's no point in just saying there are x number of staff nurses if none are drug assessed, confident to look after very sick patients etc. etc.
    publishing actual staffing levels/skill mix is a good idea, only if immediate action is taken when it will inevitably prove that there are not enough staff with the right skills on each shift up and down the country.

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  • I agree with the comments re: numbers, skill mix and patient dependency.

    But it really does speak volumes about nurse education if registered nurses are not fit to administer drugs! We've had these discussions before about obsession with certification over competence (they are not the same thing), but it cannot be acceptable that there are registered nurses who are deemed not fit to administer drugs, working in wards. Might as well be an HCA and not bother going to uni.

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  • All well and good but when we are being told that we (who is this we, certainly not the well paid managers) are over budget so we cannot book more staff and just get on with it repeatedly, how will this actually work? Skill mix and patient acuity never seem to be measured together so the ward may be well staffed but the reality is very different.

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  • I nearly spat my porridge at the telly this morning! Publicise the staffing levels will help build public confidence in the wards and NHS as a whole - REALLY!!!??? I don't bloody think so! We have been crying/screaming the problem comes from having inadequate levels of competent staff on the wards to ensure high standards of care!! For goodness sakes will these people actually get real and meet up with the people who know - the nurses. This is yet another thing that will drive an already downtrodden and demoralised group of staff out of the door!
    It is time that our unions listened to our concerns and acted on them with industrial action to ensure adequate staffing levels in all areas!!
    I think we should all contact our MP's and voice our concerns and do it more than once!! Hopefully having an inbox full of e-mails from concerned nurses might actually make them talk and listen to us!

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  • As a professional chartered engineer ( yes- I am not in health care), I quite rightly agree that one nurse to eight patient is not enough (as per one of the comments), as patient care may require two or more nurse per patient for patient recovery. There has to be a core number of staff depending on the type of ward, plus additional staff from reserve to perform some daily task assessed from closely working with the ward in question.

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  • Anonymous | 18-Sep-2013 10:14 am
    "It is time that our unions listened to our concerns and acted on them with industrial action to ensure adequate staffing levels in all areas!!"


    I agree. But nurses, who are the union membership are required to vote in union ballots to give the union a mandate to act. Nurses don't vote. The RCN and Unison had to abandon plans to act over the pension issue because only 16% voted at all. So nurses need to stop moaning and start acting.

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  • michael stone

    I like the idea of publishing staffing levels openly, but the methodology 'of the counting' also needs to be tightly controled and defined, to prevent 'fiddling the figures'.

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  • Why? What does the 'amount' of staff on duty mean to the public?

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  • Anonymous | 18-Sep-2013 12:21 pm

    Why? What does the 'amount' of staff on duty mean to the public?

    It means nothing. Just another box to tick so they can say the problem has been addressed.

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  • Anonymous | 18-Sep-2013 12:28 pm
    from
    Anonymous | 18-Sep-2013 12:21 pm

    Yup. That was my point.

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  • What a great idea? We can publish staffing levels next to the Daily Joke and see which gets the biggest laugh!

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  • roll up, roll up

    big prizes for the best staffed ward in the Kingdom

    fairy cakes, balloons, paper hats,

    tickets now on sale at the NMC
    don't miss this big event

    PS small print

    how much is this initiative costing?
    wouldn't the money have been better spent on more staff than just merely counting the ones we have daily?
    there seem to be so many hundreds of silly initiatives all over the land and every single one is using staff time and taking a tiny slice of the budget which might be imperceptible until we look at the whole great big balance sheet. besides with so many initiatives how does anyone keep control on them all without everybody tripping over everybody else's feet. doesn't strike me as being a very serious and efficient and cost-effective method of keeping control of a system which is meant to be concentrating on the care of its patients and those engaged to work for it!

    Roll up, Roll up - bring your ideas -
    generous prizes if they are adopted
    NHS always looking for some spanking new and bright initiative to report on! Have you clipboards and pens poised at the ready.

    Roll up, Roll up!

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  • George Kuchanny

    Anonymous | 18-Sep-2013 8:22 am

    Yes a 1:8 ratio plucked out of the air is not good. In fact very bad if you have a highly dependant patient in the group you are looking after. Plucking out of the air needs a hefty slap in the chops as a methodology.

    Anonymous | 18-Sep-2013 8:50 am

    Problem. You get the boot, let us say, because you have a terribly difficult to bear 'affliction' as some who do not give a flying one would think of it. The 'affliction' of having a conscience and getting annoyed if you are barred from an acceptable job, or heaven forbid, getting upset by watching unnecessary suffering and forced indignity.

    Dreadful thing to have that should be kicked out of you as soon as possible according to the view of some.

    You leave, the conscienceless win. Bad.

    Here's a start of things to do before zooming off to the Daily Wail and getting the elbow:

    http://www.youtube.com/user/NMCvideos?feature=watch

    Get your union rep to negotiate with your manager on PAID time to watch this pile of videos (ha! ha! I almost hear a bedlam of laughing and falling over at that!), take a notebook with you. Armed with what to do stare down any loony who demands that you compromise your professional standards.

    Tough - but the destruction of standards of care in the name of utterly simplistic efficiency and cost effectiveness is no place to go. Poor care costs. A huge amount of money as well as lives, delivering a fifth rate service at world class cost.

    And that, ladies and gentlemen, is a fact.



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  • George Kuchanny | 19-Sep-2013 3:46 am

    Nah. I'd just phone the newspaper. It worked before, when nothing else did (icluding proper channels and useless union), and I still have my job.

    Alert the media folks. Don't bother faffing about with anything else.

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  • Maybe the cost of Parliament should be published daily, so that we can see just how (in)efficient they are on a profit and loss basis. Give us the staff and let us do our jobs.

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  • Anonymous | 18-Sep-2013 12:21 pm

    Why? What does the 'amount' of staff on duty mean to the public?

    I totally agree, if they are determined to publish how many nurses are on the ward then they also need to publish the following:

    1) What time breaks are.
    2) What the acceptable ratio of nurses to patients is for the area.
    3) The number of patients on the ward.
    4) The number of patients who require a high level of care.
    5) The number of patients who are completely dependent.
    6) How many managers are overseeing the ward.
    7) How many nurses are trained in which specific areas.
    8) The number of wards in other parts of the hospital that are short staffed and that will require reducing staff on current ward to ensure some care gets done.
    9) The number of telephone calls from relatives, and length of time each one takes, so removing staff from the shop floor.
    10) The number of patients leaving for procedures that require an escort.

    There are more but I have run out of time. I think once these are published the public would say, I don't really care, I want to speak to a nurse now.

    Says it all really!

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  • obviously any figures published will have to be meaningful to the public and to the staff and serve a useful purpose.

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  • 1:8 is a rubbish concept for staffing. In elderly care where l work, many of our patients are 'double handed' care. When there's only 3 of you on duty for 16 patients, someone has to wait - we are not miracle workers but we do our best.

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