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New staffing guidance is 'giant leap forward', says nurse leader

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The government’s new guidance on staffing levels should be seen as a “giant step forward” to “normalise” what is already “business as usual” in some of the best NHS organisations.

The guidance, announced last week as part of the government’s full response to the Francis report, expects all hospitals to public staffing levels on a ward-by-ward basis together with the percentage of shifts meeting safe staffing guidelines from next April

Ruth May NHS England’s director of nursing for Midland and the East led the development of the new guidance for boards on staffing.

Speaking at the CNO’s Summit, she said that whilst there was evidence that poor staffing could lead to overly restrictive or abusive practice it was not up to the government to set minimum staffing levels.

“It is a board’s responsibility to ensure safe staffing on a shift by shift basis…This is about us as leaders using our expertise to decide what is best locally.”

Dr May also warned that boards would need to watch closely for any “unintended consequences” to changes they made in staffing levels.

“We need to be extremely careful in fixing the problems of today that we are not creating another for the leaders of tomorrow,” she said.

She reiterated that the National Institute for Health and Care Excellence would be publishing guidance on acute adult in-patient staffing levels in July 2014 and this would then be rolled out to other areas of the service from August.

Professor Gillian Leng, NICE deputy chief executive, told delegates that the guidance the organisation would produce should be “overlaid” at a local level.

During a question and answer session that followed, Professor Jill Maben from the National Nursing Research Unit suggested that falling below a ratio of one nurse for every eight patients should be considered a “never event”.

But Dean Royles, chief executive of NHS Employers, said that making it a never event would be the same as setting a mandatory level – a move so far rejected by his organisation and the government.

“It is really important that boards make their own judgement,” he added.


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Readers' comments (1)

  • A combination of minimum staffing levels with acuity scores of each patient for additional staff should be implemented.

    Ratio 1:8 was the figure plucked out due to evidence of increased mortality rates from around this level.
    It would make sense not to run things so close to the bone, as set as a minimum of 1:6 (registered nurse:patients) and (minimum of 1 healthcare support worker) on general wards (and more registered staff for higher dependency areas).
    Then based on the patients requirements and acuity levels; add more staff (registered and non-registered staff) as required.

    But all of this would cost a lot more money. However, how much are lives worth and the improvement of outcomes for patients? There would also be less burnout of staff and making less mistakes if not stretched to the limits of safe care.

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