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Francis response: CNO promises ‘relentless focus’ on safety and staffing levels

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NHS England chief nursing officer Jane Cummings has revealed further details of new guidance for trusts on staffing levels ahead of the government’s response to the Francis report.

As reported on Saturday by Nursing Times, which has obtained a draft of the document, the guidance will require trusts to review and publish their staffing levels at ward level.

Ms Cummings appeared on the BBC Radio 4 Today programme this morning prior to the government’s publication of its full response to the Francis report into Mid Staffordshire Foundation Trust, which made 290 recommendations in February.

Ms Cummings was asked what the “answer was” to prevent another situation like the care failings at Mid Staffordshire.

She highlighted the national nursing strategy, Compassion in Practice, which was launched in 2012 and includes the “6Cs”.

She added: “I think the other thing we need to do is have a relentless focus on making sure patients are cared for safely, with compassion and that there are enough staff to provide that care.”

She confirmed that the “How To” guidance on staffing levels, previously revealed by Nursing Times, would be published today in conjunction with the NHS National Quality Board.

“We are suggesting organisations use evidence to determine their staffing levels. Those staffing levels should be appropriate for the care the patients on each particular ward needs. That will vary from ward to ward,” Ms Cummings said.

“They should publish and discuss [staffing levels]. They should be able to describe to their patients and talk with their staff about what those staffing levels should be.”

Ms Cummings said trusts would be expected to “say that on ward x there needs to be this number of nurses on each shift and this is the number we have actually got – and if there’s a gap, what the gap is, what’s the impact and what are we doing about it”.

She added that while trusts would determine their staffing levels locally, they would be evaluated and assessed by commissioners and the healthcare regulators.

However, Ms Cummings maintained the government’s previous position against the introduction of a single minimum staffing level for most hospital wards.

In particular, she was asked whether there was already evidence for a minimum of one nurse to eight patients. This is the ratio backed by the Safe Staffing Alliance, based on evidence from the National Nursing Research Unit.  

But Ms Cummings said: “The risk of doing anything that sets a number or target like that is that it could become a maximum.

“Some people do talk about a minimum of 1:8 and that may be appropriate on some wards but for many it won’t.  There’s a real danger that we concentrate on a number without thinking about what’s needed for those patients.” 

She added that the government and NHS England were also focusing on culture in the health service.

“Staffing numbers themselves are important but what’s absolutely vital is that we look at the culture of an organisation – that is has a culture of openness where people can speak up, whether there is transparency.

“It’s about making staff feel supported and enabled to be able to speak up and that’s really, really, important,” she said.

The CNO also signalled that the government’s response would reject the Francis report’s recommendation that healthcare assistants should be regulated.

“The most important thing around HCAs is to concentrate on, not only recruiting staff on the basis of their values and behaviour, but also to make sure they have the right education.

“That’s the priority for us, to make sure that staff that deliver fundamental care to patients day-in, day-out have got the training and support to be able to do that effectively and with compassion,” she said.

Ms Cummings spoke after Debbie Hazeldine had given an emotional description of the poor care received by her mother at Mid Staffordshire. 

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