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Minimum nurse-patient ratios urged by Unison

Ministers should roll out minimum nurse-to-patient ratios in hospitals, a union has said.

Unison called on the government to introduce minimum staffing levels to ensure safe patient care.

In the public inquiry report into the serious care failings at Mid Staffordshire Foundation Trust, inquiry chair Robert Francis QC said officials should consider the “benefits and value for money of possible staff-patient ratios”.

The union said the “life saving” initiative would provide a “safer, more caring environment” for patients and staff.

It made its comments after a poll of 1,500 nurses, midwives and healthcare assistants found that 45% were looking after eight or more patients on a typical shift.

Three-fifths of those surveyed said they did not have enough time to deliver safe, dignified and compassionate patient care.

And 85% said they support set minimum nurse-to-patient ratios.

“This survey exposes a health service under severe strain, where nurses are struggling to deliver the high levels of care that they set themselves on a daily basis,” said Christina McAnea, head of health at Unison.

“On this typical day many staff worked through their break and stayed after their shift - but this still did not give them enough time to complete all their tasks.

“The hidden voice in the survey must surely be that of the patient who is not getting the level of care they are entitled to expect.

“The government cannot escape its responsibilities to the NHS by pointing the finger at staff or managers. Trusts are not being given the finance they need to deliver a growing and complex health service that demands highly expensive equipment, high-tech treatment and costly drugs.

“Government cuts are making matters worse by reducing staff, including nurses, at a time when patient demand is growing. Introducing minimum nurse to patient ratios would provide a safety net of care, restore public confidence and show nursing staff they are respected and valued.”

Sue Covill, director of employment services at the NHS Employers organisation, said: “Every hospital has different demands on its services and we should be alert to the dangers of some ‘one size fits all’ approaches. We believe arbitrary national minimum staffing ratios would limit how hospitals could plan resources in a way that’s best for their patients.

“We are pleased that the government’s response to the Francis report supports our view that it is local NHS organisations which are best placed to take responsibility for minimum staffing levels and skill mix.”

The survey results were released ahead of the union’s annual health conference in Glasgow next week.

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Readers' comments (19)


  • Having the correct staff-patient ratios means having the right number of the right staff - not having a 'floating' supernumerary manager as part of the numbers, not having an agency nurse who cannot do medication, IVs or look after acutely sick patients, not having a 'co-ordinator' who hasn't the time to look after anyone because they get tied up with everything else.

    It is not just a paper exercise, looks good and ticks the boxes if we have 4 on but in reality only 2 are in a position to look after patients.

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  • This will never happen, they'd have to spend money on wages then!

    Let's face it, this is what it boils down to. Not patient care.

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  • Australian nurses were willing to strike for this... will we? And will our unions back us?

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  • Will we back the unions?

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  • what do you think when 8 or 10 Neurologicall ill male patients are allocated for 1 nurse and 1 HCA,all of them are fully depended and need 2 hourly turning and 1 0r 2 patients are GCS of 8-10 to monitor closely,can this nurse give attention to give safe care to all of the other 9 patients?Helpless HCA how to co-op this stress nurse put pressure saying do that do this without failling a single minute free without having concern to find ot whether HCA has had any break or eaten anything................do you think these patients are can be handle by one HCA,Nurse is always busy with poorly ill patient and medication and paper work,What a safe care patients receive,this is a serious situation need to be corrected before the staff whom you FLEE

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  • which NHS is Sue Covill looking at? all hospitals and community services are under pressure. In any case there is a maximum amount of work and number of patients any nurse can safely cope with. Where i work its one RN to 15 all acute eldery medical patients. it just got alot worse with outbreak of D&V on top of everything else

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  • To all those who lack confidence in our ability to campaign for safe staffing levels and win, I say look to other parts of the world where nurses have achieved this. Yes, this has had to be fought for and it does need strong unions and a mobilised membership, but are we really any different from nurses in Australia and the US? If you are in a union, work for it. If you are not in a union, ask yourself why not? I'm sure my union, unison, would welcome you on board with this campaign. It will be difficult, especially in this time of austerity. But surely we can produce a persuasive campaign right now, when nursing care is prominent in the news. And remember, the economy will not always be in the doldrums and we won't always have this government. Of course, those two factors are clearly linked.

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  • Mick I admire your sentiment but I'm afraid I don't share your optimism.

    "but are we really any different from nurses in Australia and the US?"

    Yes, they have a backbone and a fighting spirit. British nurses don't and are happy to be walked over and shat on from a great height.

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  • Disgusting that we have to 'fight' or go on strike just to get a decent amount of staff so that patients can be cared for properly.
    This should not even be up for debate.
    There is enough evidence to prove that more trained nurses = better patient outcome, how much more 'evidence' does the govt need?
    We think things are bad now, god help us when we get old and need to go to hospital.

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  • Anon 10.59
    Well said. If the pearl-necklaced cardiganistas of the RCN congress weren't stuck in the 50's perhaps we too could strike.
    CaMoron and the cry-baby Osbourne ain't got the cojones that the wicked witch had ( rust in pieces, the lady's not returning), and we must act to prevent the destruction of the NHS before the next election.

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  • I wonder just how far Unison members will be willing to go to back this. Right now is probably our best, maybe only, opportunity for the next decade or more to get minimum ratios on the statute book. But it needs the unions to step up and finally stop being meekly complicit with government strategy. Simply issuing a press release is going to accomplish very little.

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  • we shouldn't have to go on strike, patients are entitled to a high level of care, nurses are entitled to provide that high level of care.
    1-14 seems to be the norm where I work which is a absolute disgrace.

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  • It is everyone's focus on patient care, safe care and quality care...............have you thought of the people who deliver this care, their occupational health, and their fitness at this point of very stressful environment,no break which means no energy supply to carry on the task and wait and continue the loaded task after due time what a emotional stress leaving children and family behind continuing 12 hour shift and still has to stay back to finish the task,there wasn't any free time to give call n find out how they do.................can this staff deliver quality and passionate care? are not the fragile and vulnarable ill patients at risk ?are these staff will look for alternative income and flee from this area of profession? every day you will produce staff and very soon they leave and every day you will face the challenge of shortage staff isssue,If you care your staff and give safe ratio for quality practice, will not help to solve this issue in long term consideration.................those who are responsible to think of........

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  • we need more doctors and more nurses per patient, that is just common sense. anyone working in the nhs (don't know about the private sector) will tell you that there is never enough time, never enough staff and never enough resources to do their job properly. any patient or visitor to the ward will also tell you this, it is the same up and down the country.

    what exactly does it take for anyone to take any notice of what staff have been saying?

    presumably those people who reject our concerns go private or hire in private nurses to care for their relatives.

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  • Anonymous | 20-Apr-2013 6:34 pm

    I totally agree, no hc workers should ever be pushed so far as to even think they need to strike. They have other preoccupations, priorities and duties which are far more important.


    Maybe somebody should be examining and addressing this driving force behind this need to strike, which boils down first and foremost to adequate and appropriately qualified staffing and other resources which may be lacking.

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  • What Tosh!
    If you only allow for a 'minimum' nurse patient ratio on the wards, what happens when a member of staff fails to turn up for duty?
    The other staff will have no option but to take on the additional 'work load'.
    Ward staffing levels need to be 'flexible' enough to maintain high levels of nursing care at all times.
    Yes, I know, it wont happen....???

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  • hopefully we won't be in a position when we only have the 'minimum' amount of staff on, there should be a set RN-patient and HCA-patient ratio and this must be the absolute minimum. If someone goes off sick or doesn't turn up and you end up with less then your 'minimum' then you should be able to close beds, go out to agency without having all the red tape that goes with it or insist that one of the many nursey managers comes in and works on the ward. That's how it was in the 90's where I trained, not enough staff then we closed the beds and the 'unit manager' had to come and help.
    Why should it be any different today?

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  • Maybe all nurses, doctors - anyone in the NHS - have just got used to working unpaid overtime, having little or no breaks, rushing around like maniacs trying to get their work done, offering sub-standard care - can any of us actually remember what it is like to go home and feel you have had a really good day, made a difference, feel satisfied that we have looked after all our patients to the standard we set ourselves? I know I don't.

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  • Re-posting my contribution from the other nurse staffing article in this issue.

    Nurse staffing in different clinical areas can be estimated through a number of methods some of which are highly sophisticated. They take into account acuity and dependency and allow the estimate to be tailored to the local environment and clinical circumstances, rather than imposing a nationally set minimum ratio.

    "A huge amount of work has already been done on nurse staffing which includes looking at patient acuity and dependency in different care situations. See:
    http://www.aukuh.org.uk/index.php/affiliate-groups/directors-of-nursing/patient-care-portfolio and also http://www.institute.nhs.uk/quality_and_value/introduction/safer_nursing_care_tool.html/ and the review by the NHSIII and
    http://cno.dh.gov.uk/2013/01/15/right-people-right-place-right-time/

    Also check out the work done by Keith Hurst which informed much of the SNCT development and the "Guidance on Safe Nurse Staffing Levels in the UK" (RCN, 2010) and "Setting Appropriate Ward Nurse Staffing Levels in NHS Acute Trusts" (RCN, 2006) documents on the RCN web site.

    What I find worrying is that the NHSIII has closed and the site will be discontinued in a few months (at the end of June). Searches of the NHS Commissioning Board site and NICE have failed to provide little if any information on plans to progress/develop tools for establishing nurse staffing levels. The whole issue seems to have had a veil drawn over it with a reduction in transparency about what is happening.

    There is no lack of work, tools or evidence and there appears to be a smoke and mirrors game being played by those who run the NHS in England."

    I believe we are already below the minimum required for safe and effective nursing care on many hospital wards in the UK. The results were seen at North Staffs.

    The government/DoH is worried that acknowledging the truth and addressing the situation will result in significant, and fully justified, increases in nurse staffing and costs. Which might explain the smoke and mirrors approach, the attempts to lay the blame for North Staffs at the feet of "badly recruited, badly trained and compassionless" nurses and the attempts by some consortia to reduce nurses pay by attacking Agenda for Change.

    It's time for nurses and patients to work together to put an end to this madness.

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