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Exclusive: Nurse staffing levels to be reviewed and made public


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.

Stack of reports

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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Readers' comments (12)

  • michael stone

    'Trusts will also be expected to publish staffing levels twice a year.'

    This needs to show nurses and HCAs separately, and how the numbers vary across different types of ward: I'm not 100% certain how to define the metric for the following, but a measure of how many of the staff are actually 'close to patients and directly involved interactively with' in real-time ongoing physical terms (as opposed to engaged in paperwork, etc) would be useful as well, I think.

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  • Evidence Reviews Contract – Safe Staffing Levels

    Production of evidence reviews to inform the development of the NICE guideline on safe staffing in adult inpatient wards.

    Reference number: SSL 11 2013

    Deadline date:29/11/2013

    This deadline is for… Tender submission

    Contract value:£0 – £80,000

    Location where the contract is to be carried out: London

    Is this suitable for smaller suppliers? Yes

    Is this contract suitable for a voluntary, community and social enterprise organisations? Yes

    Name of the buying organisation: National Institute for Health and Care Excellence

    Description of the contract

    Production of evidence reviews to inform the development of the NICE guideline on safe staffing in adult inpatient wards. NICE, established under the Health and Social Care Act 2012, is the executive Non Departmental Public Body responsible for providing guidance and advice to support health and social care commissioners, providers and others to make sure that the care and preventative services provided are of the best possible quality and offers the best value for money. NICE has a statutory role that encompasses the development of quality standards, advice, information and recommendations about NHS, public health and social care services. NICE provides independent, evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health and reduce health inequalities, and operates an independent accreditation programme to validate the guidance production of external organisations. It is anticipated that NICE will be asked by the Department of Health (DH) to develop new guideline outputs which focuses on safe staffing levels. It is envisaged that these guidelines will support local decisions making in a range of NHS settings and will also be of relevance to non-NHS bodies that provide care for NHS patients. The guidelines may also be a useful resource to patients and carers. We expect to receive the first guideline topic referral from the DH in November 2013 and anticipate that this will focus on safe nurse staffing levels, including nurse support staff, for acute adult in-patient wards in the NHS. The guideline will provide recommendations for safe staffing levels for the specific area referred by the DH. The first guideline topic is due to be published in July 2014. NICE would now like to commission a contractor to produce evidence reviews to inform the development of the first guideline topic referred by the DH. We anticipate that these outputs will review the available evidence relating to two broad areas.


    Safe Staffing Levels Tender Pack (Tender Pack for Safe Staffing, 118kb)
    Classification of the contract

    73000000 Research and development services and related consultancy services

    Additional information

    Contract type: Services – Unspecified

    Is it a framework agreement? No

    Is this contract related to a programme of funding? No

    Contract will be awarded based on: Most economically advantageous tender in terms of: The criteria stated in the contract documents

    Estimated length of contract: 7 Months

    Who to contact

    Contact name Gillian Watson

    Organisation name National Institute for Health and Care Excellence

    Address 10 Spring Gardens, London, UK, SW1A 2BU


    Extension number:



    Web address

    How to apply

    Tenderers must express an interest no later than 5pm, UK time, on 18th November 2013, by emailing Gillian Watson at Failure to submit an expression of interest by the above time and date will result in your tender being rejected.

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  • I'm not really sure what will be gained from publishing staffing levels other than to give employment to another boat-load of administrators.

    If a member of staff is off sick and not replaced how will this be reflected in the figures? Will the staffing levels be a one-day snapshot or will trusts be mandated to publish the staffing levels of every shift, everyday on every ward and department. If that is the case then there'll be too much information.

    Having worked somewhere that had a 'dependency tool' years ago, believe me this isn't the answer to all your problems. One would complete said tool then one would often be challenged to explain how 'scores' had been reached. Like most tools and risk assessments, it was very subjective and because there isn't a pool of instantly accessible staff - if you had highly dependent patients on a particular shift - it served only to highlight, retrospectively when you were short staffed and became nothing more than an utterly pointless paper exercise.

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  • No need for middle agencies/person/persons
    Too much money is being handed out to too many when we nurses are not being asked to get involved.
    In fact I can advise at a rate of £12 an hour, the pay I get after working for 25 years in the NHS. Also having a degree, intelligence, experience and good old common sense.
    Too many failed projects in the NHS.
    Money hungry people just waiting to get a bite in.
    We nurses will advise because we care ( most of us ). Just ask us.

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  • Adopt something practical and refine through experience. There is a need for some way of guiding management and comissioners and informing the public.

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  • Why publish figures that mean nothing? Without any idea of what are appropriate staffing levels for each area, unit, ward, community settings, etc., any published figures are meaningless. We can't even agree on how to determine adequate staffing levels. This is yet another pointless stunt to add weight to the myth that "something is being done". No it isn't. Don't waste the money or time on this.

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  • Our new matron has introduced a form to request from the managers another member of staff when we feel there is a need. However, the forms must not be kept on the wards we nurses have to request for it when we need it, the form contain so many questions to answer the nurse will spend another hour answering those questions after getting it, then having to wait for the reply from the manager.
    All this is already putting a stumbling block in the way of getting more staff.

    Publishing figures will not sort the problem.
    We need managers who could manage and intelligent enough to understand the dynamics of patients care with appropriate

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  • Anonymous | 13-Nov-2013 1:49 pm, 3rd paragraph

    I was there too, and it was open to abuse and became too expensive, so was scrapped.

    Anonymous | 13-Nov-2013 4:26 pm

    Agree with you there.

    If it happens that staffing levels are taken seriously, it will be short-lived.

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  • I wonder if managers will be encouraged to give an honest account of staffing levels and not the edited version as in the area I work in the number of nurses and HCA's who arrive to do a shift on the unit is certainly not the number that are still in the unit an hour or two into the shift, as they are taken to cover even shorter areas. Also will they take into the ones who are off sick? This could be a very effective and honest account of nursing levels or simply another paper pushing exercise to try and pull the wool over the government and the public's eyes! I guess time will tell!

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  • This is nothing but a cheap stunt by the Government: you know "honesty is the best policy" and "sunlight is the best disinfectant" etc., etc., you can imagine all the other sound-bites and metaphors that will flow from Whitehall proclaiming that the Government is being tough on NHS Trusts and takes patient safety seriously; of course, in reality, it's doing neither.

    Every ward will be expected to provide data for every single shift of every day. Patient numbers, dependency, staff grade, staff sickness, admissions and discharges will all likely to have to be recorded. Can u imagine how much data will be produced. Even if every ward and department in England produced one side of A4 per week that's 52 pages a year - just imagine the volume.

    Every six months, the DoH will dump (and what a dump it will be) into the ether hundreds of thousands of pages of utterly useless data. The sheer volume of it will bury anything remotely interesting and I think Journalists will lose interest quite quickly.

    I'm yet to find two hospitals that are identical so it will be impossible to make a direct comparison between two and as the government is not setting minimum staffing levels again, comparing ward against ward will be very difficult.

    This is a revenue-neutral way for central government to look tough, it's a complete publicity-zest unit and nothing more.

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