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Carter Review's care hours metric 'too blunt a tool', warns peer

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A proposed nursing care metric set to be introduced by the NHS is “too blunt a tool” and could be “meaningless” for workforce planning, according to an influential peer.

Lord Willis argued that the care hours metric, proposed by fellow peer Lord Carter in a major productivity review for the government, did not sufficiently take account into the skills of different parts of the workforce.

“Instead of looking at the metric we need to be looking at the outcomes for patients”

Lord Willis

Lord Carter’s review, published last month, recommended the care hours per patient day metric become the “principal measure of nursing and care support deployment” in the NHS from April this year.

It is calculated by adding the hours of registered nurses to hours of healthcare support workers and dividing the total by every 24 hours of inpatient admissions.

But Lord Willis, who himself chaired the Shape of Caring review on nurse education and training last year, said there was a “potential risk” that trusts could be tempted to employ more healthcare assistants to increase their average care hours at the expense of registered nurses.


Carter review to back new measure of nurse productivity

Lord Carter

He said: “I thought Lord Carter’s work was really quite an excellent report. I thought his analysis of where we could make significant savings bottom upwards was terrific.

“Where I found it hard to support him, was that the metrics which he designed did not take into consideration the actual skills of the whole staff, not just registered workforce but also the support staff. At the moment it is very difficult to quantify the skills of the associate workforce. Unless you can do that you cannot then just have a simple metric,” he told Nursing Times’ sister title Health Service Journal.

“It is too blunt a tool to actually guarantee the sort of care that patients like I and many others would like to see,” he said. “It does need to actually factor in the skills of that workforce otherwise its meaningless.”

Lord Willis

Lord Willis

Lord Willis

While Lord Willis accepted there was a “potential risk” of trusts employing more HCAs, he said this could be appropriate for some care settings and that it was important registered nurses were used appropriately.

He said: “Instead of looking at the metric we need to be looking at the outcomes for patients.”

Lord Willis is currently continuing his work with Health Education England on implementing recommendations form the Shape of Caring Review.

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Readers' comments (1)

  • michael stone

    I'm with Lord Willis on this - you MUST 'get the metric right' and the right metric must be 'impossible to game'.

    This tendency to go for 'overly-simplistic metrics' and to then 'claim their use leads to robust quality assessments' is all-too-common.

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