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Prime minister's forum finds 'overwhelming concern about staffing'

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”.

Readers' comments (22)

  • King Vulture

    If my memory serves me properly, and it often doesn't, I heard DC comment to the effect that 'we act on the bits of reports we agree with' a few days ago: that makes 'reports', and other expert opinion, fairly pointless !

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  • Did we really need a Forum to report on the bleeding obvious????

    Nurses and nurse managers have been reporting this for years.

    What next, "Nurses report unmanageable pressure on beds as numbers reduce"?

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  • Why should ward sisters and team leaders be supernumary? shouldn't they be out on the wards teaching and assessing staff, passing on their clinical knowledge and being seen to be looking after patients.

    Staff nurses are 'expected to be in charge and manage a case-load' when the ward sister is on annual leave or off sick.

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  • Tipparary Tim -

    maybe we do, although as has been suggested above, DC may just ignore the bad news bits - he has form in this area.

    Anonymous -

    Agreed : team leaders should be on the ward `mucking in` as I`m sure many would like to but this is difficult with the amount of beaurocracy expected of them. A staff nurse is in charge nominally but the team leader is ultimately accountable if the audit isn`t done etc.

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  • Anonymous | 28-May-2012 11:18 am

    good grief, don't start grumbling about 'supernumerary' as well. everybody agrees that there is a staffing shortage so surely the more the better.

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  • Tipperary Tim | 28-May-2012 11:05 am

    that's what i thought,

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  • how about asking the PM to set up a forum to report on all the reports that have been reported on to date? then a report on the progress being made could be reported on.

    Reporting ad infinitum

    only half listening to the news today I was surprised at hearing the leader of one country saying they did not want another UN report on their situation they needed action - I couldn't help smiling and thinking the love of reports and the hate of action until things really come to a head sounded very familiar and must be something which is deeply inherent in human nature for all except those on the front line and their recipients of support and care!

    It seems that only when something really serious happens to make the government sit up and take notice will anything be done to alleviate this current situation of staff shortages - the Olympics maybe?
    After all surely it is not in our best interests to make a bad impression on our foreign visitors which could damage our tourist industry and our economy even further?

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  • "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.”"

    so how much longer will all this take? how many more patients will suffer or lose their lives and destroy families as a result?

    Perhaps some data on this should be collected and published in the national press regularly.

    if it is going to take such a long time, by the time this issue is resolved there will be many others and resources will probably still be totally inadequate. It just seems that nurses have the solutions but those in charge are unable to make any decisions on how to implement them. All they understand are unlimited discussions and report filing with an occasional recommendation which stands very little chance of ever being acted upon.

    with regards to these staffing level tools, if these are available why isn't every hospital in the land using them? and why isn't somebody there to ensure that they do? this should be law with strict punitive measures for those who fail to comply with it.

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  • Anonymous

    'It seems that only when something really serious happens to make the government sit up and take notice will anything be done ...'

    The problem, and I admit this doesn't really fit with staff shortages, is that when 'the bad headline breaks' you usually get some sort of half-baked knee-jerk reaction, and that tends to make things worse instead of better.

    Perhaps if the patients responding to 'would you recommend this place to a relative ?' write lots of 'No - the staff are lovely, on the rare occasions I could attract one, but there simply aren't enough nurses' comments, then the standard 'there are enough of you' line might start to be broken ? Or, just perhaps, the 'patient comment' idea might get quitely dropped !

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  • patients can and often do find the staff lovely or may say so to avoid offence but this is no guarantee of high standards or even appropriate medical care - just gilt on the gingerbread!

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  • I certainly don't think senior staff should be supernumary - we should be leaders - by example - not managers stuck with admin that has been delegated down by non clinical managers and could often be done by an administrator. Of course we could also ask for a concerted effort to be made to reduce how much we do things in triplicate. It seems at present that everyone has something else that nurses 'must do' - all these extras take away clinical time. If senior clinical staff become supernumary they will simply be handed loads more admin to do to take away from senior managers. At some point we have to reverse all the administration that divides and multiples at an alarming rate. We have just had a much awaited restructure of management and guess what no less management - just more work passed down to clinicians with the usual this is important and you must do it, asking how we fit this in - is just more time wasted.

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  • tinkerbell

    Matthew Birks | 28-May-2012 11:38 am

    Agreed : team leaders should be on the ward `mucking in` as I`m sure many would like to but this is difficult with the amount of beaurocracy expected of them. A staff nurse is in charge nominally but the team leader is ultimately accountable if the audit isn`t done etc

    As a team leader i agree, i am not some remote person, i am in there with my team working with them mucking in every shift. If i were supernummary i would still muck in. If they put me in a position where i have no patient contact then i am not a hands on nurse and i would go back to being a staff nurse. I have done in the past. I left an office bod job to become a nurse not vice versa.

    I have managed to get by for many years doing the least amount of paperwork i can unless it is a top priority, i make that decision. I think if half of it was put in the bin no one would even notice.

    We have 3 team leaders across our unit and none of us are office bods. We're out there with our staff getting stuck in, sleeves rolled up and rolling about in the do dah.

    I know everything that is going on with the patient care because i am involved every shift with the patient care.

    David Cameron want some advice come to our unit and see how our team leaders lead, by example.

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  • In reply to Cassandra, you sound like a good leader, not all 'muck in' as I am sure you are fully aware and many do sit in the office doing admin every shift. A lot of this admin also gets allocated to the staff nurses - audits, rota etc.

    I have worked with senior staff who don't remember what 'do dah' is - it's usually something other people deal with.

    I thought there was talk of having sisters back on the wards, being supported by ward matrons.

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  • Ah Cassandra.......the government will never heed your predictions (regardless of avatar). You doomed to never being heard or acknowledged!! But you never stop trying and that is deserving, at least, of a big pat on the head/wings!

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  • I am a team leader [community not ward] and I filled in the survey for this panel and said that leaders should not be supernumary. Might have known loads would opt for the supernumary though. Shame - and it won't make life any easier as admin just keeps on growing. It is so true that most could be binned with no detrimental effect on care.

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  • tinkerbell

    Mags | 29-May-2012 12:45 pm

    Fellow Cassandras

    Alas you too Mags and others, tim, red paddy, toby, lorraine, yvonne, some other anonymouses, sorry to miss out anyone, who can see where all this is leading and would like for us all to take some action but nobody's listening.

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  • tinkerbell

    and mike of course.

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  • It seems to me that there is some misunderstanding about what supernumary means. In my view - and this seems to be what the article means too - supernumary means not having your own caseload of patients so that you do have time to work with, teach and supervise your staff. It is supernumary clinical time - not extra time to be in the office doing paperwork. But also why have nurses taken on so much paperwork without demanding additional administrative/secretarial support - there is a great deal of paperwork which does not require a qualified nurse to do it and which could be done by a good ward secretary. We should be primarily concentrating on patient care whether we are supernumary or not.

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  • I'm really, really sorry but the word is supernumerary, not supernumary. I am's an illness, I know......but I just can't take it anymore. Phew. I feel so much better. I'm off to take my anti-pedant pill. I don't think the medication is working.

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