The government will order hospital boards to review and publish their staffing levels twice a year in its final response to the Francis report, Nursing Times understands – but it will not set out a minimum staffing level or skill mix ratio.
The much anticipated final response to the public inquiry into care failings at Mid Staffordshire Hospital Foundation Trust is expected later this month.
Nursing Times has learnt that the centrepiece of the government’s response on nurse staffing will be the launch of a new “How To” guide on staffing levels.
It will set out a series of “expectations”, including that hospitals should use recognised evidence based tools to determine appropriate staffing levels and review them on a regular basis. Trusts will also be expected to publish staffing levels twice a year.
Nursing Times understands the guidance will say boards should make sure they have a good understanding of staffing levels down to ward level and not just across the organisations.
The government is also expected to reconfirm it will commission the National Institute for Health and Care Excellence to develop guidance on service specific staffing levels, for example older people’s wards and surgical wards.
NICE is expected to take up to 18 months to develop its guidance, so the How To document may be welcomed as something that can be acted on immediately.
The development of nationally recognised tools for establishing appropriate staffing levels was one of the 290 recommendations made by Robert Francis QC in his report from the Mid Staffordshire Foundation Trust public inquiry.
The Francis report
The inquiry heard that some wards there had dangerously low staffing levels, leading patient care to suffer. Despite this, Mr Francis stopped short of using his report to call for an overall minimum staffing level.
However, in August Mr Francis said he had subsequently become convinced by evidence from the Safe Staffing Alliance. The alliance of nursing and patient groups set up earlier this year argues that the ratio of nurses to patients should never fall below one to eight on a general acute hospital ward.
The guide’s development has been led by Ruth May, regional director of nursing for the Midlands and East.
It forms part of ongoing work on the chief nursing officer’s strategy Compassion in Practice, which set out similar proposals around transparency on staffing levels when it was first launched a year ago.
However, the guide will be published by the NHS National Quality Board, rather than the CNO’s office. The quality board includes representatives from the Care Quality Commission, Department of Health and the NHS Trust Development Authority.
Ms May told Nursing Times that passing the document to the quality board would ensure it had the support of the organisations involved in regulating and performance managing hospitals.
She said: “Some of the expectations are already published in the CNO’s strategy: the use of evidence based tools, making sure we publish staffing levels, boards considering staffing every six months.
“We wanted it to be a national quality board guide so it would have much more bite,” she added.
Ms May declined to comment on whether it would set a minimum level or ratios. However, In line with previous rhetoric from ministers, Nursing Times understands the guide will not include a minimum staffing level or recommend a skill mix ratio of registered nurses to healthcare assistants.
It is likely to meet a lukewarm reception from unions and other campaigners who want to see firm action on staffing. However, it may be welcomed as an acknowledgement that having appropriate numbers of staff is essential to delivering safe, good quality patient care.
It also marks a change in tone from the government’s initial response to the report in February. The flagship proposal in the response was that aspiring nurses should work as HCAs for a year before gaining entry onto a nursing course to ensure they had the right values.
The move was widely interpreted as an attempt by ministers to blame poor care on a lack of compassion among the profession, rather than a result of overstretched staff.
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