A leading nurse staffing expert has warned that the “lessons of Francis” are starting to be “forgotten”, due to NHS trusts increasingly being expected to focus on finances over safe nurse staffing levels.
Professor Peter Griffiths, chair of health services research at the University of Southampton, said recent comments by regulators had wrongly indicated a ratio of one nurse to eight patients in hospitals was “generous”.
“That attention [on nurse staffing] has not yet completely gone but it is remarkable how quickly the lessons of Francis are being forgotten”
The body that produced staffing guidance following the Francis inquiry into the former Mid Staffordshire NHS Foundation Trust had in fact found that when a hospital nurse had more than this number of patients there was an increased risk of harm, he said, meaning problems were occurring before that point.
Professor Griffiths, who is also the former director of the National Nursing Research Unit at King’s College London, said: “Our starting point should not be ‘can we afford enough nurses’, but ‘can we afford not to have them?’.
“It was one of the key lessons from the Francis inquiry and, when the inquiry [report] came out, there was a moment where attention was focussed on nurse staffing,” he told delegates at a safe staffing conference in Birmingham yesterday.
“That attention has not yet completely gone, but it is remarkable how quickly the lessons of Francis are being forgotten,” he said to the group of chief nurses and workforce experts.
“It now feels as though we are heading back to a situation where we have to justify the expense of nursing. But you should not have to justify a good staffing level”
He later reiterated to Nursing Times that the review of evidence for nurse staffing in adult inpatient wards in acute hospitals – by the National Institute of Health and Care Excellence in 2014 – found there was an increased risk of harm during day shifts if the nurse-to-patient ratio went beyond 1:8.
“More recently comments from some at [regulator] NHS Improvement suggest that ratio is generous,” said Professor Griffiths.
He warned that “plausible” arguments had been made to reduce staffing levels at Mid Staffordshire – but without considering the risk to patient care.
“It now feels as though we are heading back to a situation where we have to justify the expense of nursing. But you should not have to justify a good staffing level,” he stressed to Nursing Times.
During his presentation, Professor Griffiths also highlighted that harm may be occurring before the 1:8 ratio was reached.
“A ratio of 1:8 is not a target threshold. It is not the magic number. It is a bare minimum. Starting at that level may already be inadequate”
Following another review of the evidence that he helped lead for new staffing guidelines being produced by NHS Improvement, Professor Griffiths said he believed 1:8 should not be viewed as a “target” safe level, as many NHS organisations had done.
“A ratio of 1:8 is not a target threshold. It is not the magic number. It is a bare minimum. Starting at that level may already be inadequate. Patients are probably already at risk,” he said at the Healthcare Conferences UK event.
He said evidence showed that, across a number of patient and staff outcomes, once a nurse had more than eight patients to care for “bad outcomes are happening with substantially significantly increased frequency”.
“By 1:8 and beyond, the bad stuff is already happening, which is why 1:8 should start setting alarm bells going,” he said, adding that he believed a safe staffing ratio was at a lower level than this.
Earlier this month, Sir Robert Francis himself warned that financial and demand pressures on the NHS had created an environment in which a care scandal equal to that at Mid Staffordshire is “inevitable”.
In an in-depth interview to mark the fourth anniversary of the publication of his landmark report, Sir Robert said the NHS was facing an “existential crisis”, and was “manifestly failing” to keep pace with demand.