Inspectors should crack down on hospitals that do not regularly review nurse staffing levels, according to the group commissioned by the prime minister to help drive up NHS care standards.
Sisters and other team leaders should also be counted as “supernumerary” on rotas in recognition of their important leadership role, the Nursing and Care Quality Forum said in a letter to David Cameron on Friday.
The forum, which was announced in January, said many people had told it they were worried about understaffing and the skill mix balance between nurses and support workers.
The letter, setting out early recommendations from the forum’s review, said: “We heard overwhelmingly that staff are concerned about staffing levels and skill mix and the impact this has on the quality and safety of care, and experience.”
Although the letter noted that staffing and skill mix was only “part of the picture” of why poor care existed, it called on trust boards to review whether they had safe levels and skills mix at least twice each year.
It also recommended that the Care Quality Commission use routine inspections to check organisations were carrying out these reviews, and “taking appropriate action where levels expose concerns”.
Salford Royal Foundation Trust chief nurse Elaine Inglesby, who is leading the forum’s workstream on “time to care”, told Nursing Times it was not known how many trusts currently carried out reviews using staffing tools.
She said: “Nurses told us they felt staffing levels on occasions weren’t safe. That leads us to believe organisations aren’t always using the tools.”
Another forum recommendation was that ward sisters and team leaders should no longer be included in rotas as routine care providers. The letter said it was currently “standard practice” for them to be “expected to be both in-charge but also to manage a caseload”.
It said nursing team leaders “should be fully in charge and supernumerary” so they have “time to lead and be accountable for their clinical area”.
Ms Inglesby acknowledged such changes would not happen straight away, as they might require extra financial resources. She said: “None of this is going to be immediate. There is more work for us to do now.”
Coinciding with the letter, Mr Cameron announced the rollout of new quality indicator, based on asking patients whether they would recommend a hospital to their friends and family. The indicator, similar to that already present in the NHS staff survey, was backed by the forum.
Ms Inglesby cautioned that the indicator should not be used on its own to judge “good or poor nursing”.