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CQC should use staffing levels as 'early warning', says nurse forum chief


A group of senior nurses are calling on the Care Quality Commission to monitor nurse staffing levels as an “early warning” of where poor care is likely to happen, Nursing Times has been told.

The call comes in response to comments by the CQC’s new chief inspector of hospitals Professor Sir Mike Richards, following a high profile review of the 14 acute trusts with highest mortality rates in England.

The review, published earlier this month by NHS England medical director Sir Bruce Keogh, revealed all 14 trusts were understaffed.

Despite this Sir Mike told Nursing Times the regulator would not be monitoring staffing levels as part of its new hospital surveillance regime. Instead, the CQC would look at staffing levels as an “explanatory” factor if there was other evidence of poor care.

But Sally Brearley, chair of the Prime Minister’s Forum on Nursing and Care Quality, said there was concern about this stance among her group’s members.  

Health secretary Jeremy Hunt has asked the forum to work with the regulator on the development of its new inspection regime.

The forum, which includes Midlands and East director of nursing Ruth May who led some of the Keogh review teams, plan to raise its concerns with the CQC.

 “We feel that things like nurse staffing would be much more helpful as an early warning rather than waiting until you have got problems like buzzers not being answered,” she told Nursing Times.

“We’d like the CQC to look more upstream, particularly in the wake of the Keogh review,” she said.

The government’s initial response to the Francis report into care failings at Mid Staffordshire Foundation Trust said the CQC would in future be tasked with looking at whether trusts were doing intentional rounding and whether ward sisters had supervisory status.

Ms Brearley said: “We will want to work with the CQC to make sure they’re asking the right questions and know what good intentional rounding looks like.”

The forum was set up by David Cameron in 2012 to address concerns about the quality of nursing care.

Nursing Times understands the group considered disbanding earlier this year, partly in response to concerns about plans to make aspiring nurses work as healthcare assistants for up to a year before starting their formal training.

However, members have decided to continue and will be advising the government on its full response to the Francis report, due in late October or early November.

Members will also be supporting the roll out of the national nursing strategy, Compassion in Practice.


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Readers' comments (9)

  • michael stone

    Low staffing ratios should attract more attention/monitoring than typical levels, in case there is also worse care: by collecting data on staffing levels v care outcomes, we would become better informed, and we might discover if there are operational methodologies (which don't also include flogging the staff to death) of achieving decent care with lower levels of staff (which might be more patients, as opposed to less staff - ratio remember).

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  • If staffing levels have been properly assessed for the patients on the unit for both numbers and competencies then it is not possible to provide the necessary care if the right staff and the right number of staff are not there. Why is this even being discussed at a high level , surely it is a given. Nurses have been flogged for far too long and appearing before the NMC for failing to do something on a shift, when if an overview was taken, their role on that shift for each patient was impossible. Never mind the grey suits got a bonus for meeting a target!!

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  • tinkerbell

    those areas that regularly run with low staffing levels display a culture of trying to flog a dead horse (the staff), it speaks volumes that 'they' care little for their staff and even less for the patients.

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  • Focusing purely on staffing ratios wont solve the problem I'm afraid and I think it may lull the CQC into a false sense of security.

    On the ward I work on sometimes there are three or four qualified nurses names on duty rota for twenty-four patients, but only two will actually be doing hands-on care, the other two (ward manager and her deputy) will be in an office doing god knows what.

    The CQC needs to be directly employing an inspector for each NHS Trust or geographical area and their role should be to land anytime day or night to see exactly what is going on. I don't mean once a year either, they should be there five days a week talking to patients and staff so they can see exactly what goes on in our wards and departments.

    I fear they wont do this as what they'll find is a system in crisis: where there are more patients than beds and staff to properly care for them.

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  • tinkerbell

    I agree, the unit manager and the deputy should not be included in the staffing levels if they are never hands on.

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  • Anonymous 1.18
    Yet another example of nurses criticising others without knowing what their job entails. Senior staff are in the office doing "God knows what". OK, how about asking if you can shadow them for a day, and/or have a discussion about what their role and responsibilites are, and then you can offer any suggestions about how they could do things better.They would be pleased that you were interested enough to find out, rather than just whinge, and you may learn a little about what they have to do and how it contributes to the ward as a whole.

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  • Anonymous | 31-Jul-2013 11:19 pm

    The 'god knows what' comment wasn't a dig at senior staff, I was trying to make the point that my ward often appears - on paper - to be very well staffed indeed with three, four sometimes even five qualified on duty for twenty-four patients, but in reality there are usually only two nurses actually caring for patients.

    If the focus is purely on qualified numbers per patient then my place would be deemed as very well staffed when in reality it isn't and care is nowhere near as good as it should be.

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  • NHS is not a business

    Expected CQC visit to a ward in a hospital in a city in the North of England (not too far from Beverley in East Yorkshire) yesterday. Staffing on the ward was increased by 33% for the day of the visit. The visit did not take place in the end. If that is what that Trust believes is the depth of CQC looking at staffing levels then they have nothing to fear.

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  • 3-Aug-2013 10:12 am

    Yeah, same thing happened on my unit and I bet almost every other ward, department and care home in the country, that's why I think there needs to be a CQC 'presence' at each hospital all the time to keep management in check.

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