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NHS must avoid 'knee-jerk' approach to staffing levels, says Hunt


The NHS must move away from a “knee jerk” approach to staffing and stop focussing solely on increasing nurse numbers as the only way improve patient safety, according to the health secretary.

In an interview with Nursing Times, Jeremy Hunt said resources were “finite” and the NHS should look at how it can make better use of nurses’ time rather than just upping staffing levels.

“We need to move away from a knee-jerk approach that says the only way to improve patient safety is by expanding the numbers of nurses”

Jeremy Hunt

While he acknowledged trusts did need more registered nurses and the workforce should be expanded, he said quality of care depended not only on nurse numbers but how well supported staff were, their training and the amount of time they were able to spend with patients.

Mr Hunt said trusts should take a “balanced” approach to improving safety of care. He noted some organisations maintained good safety levels with relatively low numbers of nurses that spent a high proportion of their time with patients.

“The resources are finite and we need to move away from a knee-jerk approach that says the only way to improve patient safety is by expanding the numbers of nurses, and actually look at how well we use nurses’ time,” Mr Hunt told Nursing Times.

“So there are trusts where nurses spend a huge amount of time filling out forms when they want to admit someone or discharge them, where actually a proper electronic health record system could save a lot of time,” he said.

Mr Hunt also said the Care Quality Commission was clear that its requirement was for trusts to use their judgement when applying nurse to patient staffing ratios, such as the ones set out last year in guidance for general adult wards by the National Institute for Health and Care Excellence.

“The amount of time people spend in contact with patients is absolutely critical here,” he said. “So we’ve got to look at this in a smart way.”

The NHS will, from April, start using a new way of measuring nursing care, by looking at the combined number of hours of care provided by healthcare assistants and nurses together.

The new metric was set out in Lord Carter’s recently published review of NHS productivity. But, as reported by Nursing Times last week, some experts have criticised the metric, suggesting it is “too blunt a tool” for workforce planning.

They warned it could lead to trusts employing more healthcare assistants instead of increasing registered nurses, in a bid to improve the number of care hours they provide.

When asked by Nursing Times whether he believed this would happen, Mr Hunt denied it would be the care and predicted nurse demand would continue to increase.

He said the ageing population meant more nurses would be required across all settings and that the government was committed to increasing nurse numbers further.

“The question is how we reduce the pressure on the inevitable increase in workload we are going to see as a result of the ageing population. And being smart about how we use different elements of the workforce for different jobs will help us to manage that demand in a sustainable way,” he said.

Last month the BBC published data, obtained through a Freedom of Information request, showing that on 1 December 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 nursing vacancies – which it noted was equivalent to 9% of the workforce.

Meanwhile, findings published this month from a US study involving 112,000 patients in nearly 500 US hospitals highlighted the impact of nurse staffing levels on outcomes. It found that every additional patient in a nurse’s workload was associated with an 8% increased likelihood of a patient being readmitted within 30 days of discharge after knee or hip surgery.

Mr Hunt spoke to Nursing Times last week at the inaugural Global Patient Safety Summit in London, at which he also announced new measures to encourage an open reporting culture in the NHS.

They included nurses being given “credit” by the Nursing and Midwifery Council if they were honest about mistakes, and the creation of legal “safe spaces” for staff offering information about errors.

The conference brings together ministers and expert clinicians, including World Health Organization director general Margaret Chan.

Health secretary’s new measures to improve NHS safety and transparency

  • Creation of the independent Healthcare Safety Investigation Branch
  • legal protection, so called “safe spaces”, for staff giving information following a hospital mistake
  • from April 2018, expert medical examiners will independently review and confirm cause of all deaths
  • NHS Improvement to publish first annual “learning from mistakes league” to rank openness and transparency among trusts
  • Changes to General Medical Council and Nursing and Midwifery Council guidance so when NHS staff are honest about mistakes and apologise, a professional tribunal gives them credit
  • NHS Improvement to ask all trusts to publish a charter for openness and transparency so staff have clear expectations of how they will be treated if they witness clinical errors
  • NHS England will work with the Royal College of Physicians to develop a standardised method for reviewing the records of patients who have died in hospital
  • England to become first country to publish estimates for every hospital trust of avoidable mortality rates

Readers' comments (19)

  • The grave error here is to make the simple equation of time well spent between any data workload and manual care. Technological improvement for efficiency is fine but if you don't understand the causation of data workload is a problem then streamlining it is a perpetual constant nonsense. What you have in effect is a constant battle between streamlining and influx of new data types, thus a status quo error in the logic of constant improvement. You want the answer Jeremy then start looking at poorly written limitative care legislation causing direct paralysis in and to care with prevention of common sense. Your notion of balance dependent partially on mentioning low numbers working well is in fact not balance where the whole nature of the game is dynamic change which happens in an instant at the frontline. Carter's attempt is nothing less than a nonsense of the highest sense in regard to static numbers and fixed variables of care. Your dependence on the notion of time results in one thing which is less time for direct care. Productivity equated with sustainable limits is nothing less than cost cutting and heightening staff stress levels, which result in your same illogical approach of needing a continuous fix and blaming staff. The issue at hand is your wrong methodology of the sameness that has already led is to this point of worse services. At some point Jeremy you have to understand the very delusional illusional method you are using is the very method destroying the whole NHS.

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  • Why doesn't Jeremy Hunt work on the ridiculous levels of hierarchy and unnecessary specialities such as dol assessors, capacity assessors, risk assessors, quality assessors, auditors, managers for managers, modern matrons, safeguarding assessors, middle management, codifiers for codifiers, too many secretaries, Human (wasteful management resourceless) resources, CCG, CQC, NHS England, NHS Improvement - anyone else? Opps that goes against common sense! And Jeremy plus those consultants feeding you dependency cultures that won't work based onconstant psychological assaults of ever illusive performance. Yes Jeremy you guessed it we've worked it out and the wasted money your spending on consultants.

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  • Hear that everybody? We're not working hard enough, us lazy lot are the problem. Absolutely nothing to do with the horrific understaffing. no no no....

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  • I worked for many years with a full electronic record system (RIO) and it did not save any time over a paper system. Yes, some things were quicker, but others were either slower or impossible to replicate.

    The main advantage was that things were legible, however that did not matter when folk were writing ambiguous or incomprehensible notes.

    A big downside was the local NHS trusts running on slow, out of date, cumbersome software and positively archaic hardware.

    In some, if not all, areas of nursing you cannot get away from the inconvenient fact that there are only a certain number of patients a given number of nurses can deal with effectively in any set period of time.

    So, next idea then Jeremy?

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  • Mr Hunt noted that some organisations maintained good safety levels with relatively low numbers of nurses. He did not go on to name these organisations and show that he knew what % of these types of organisations are within the NHS. One cap does not fit all areas.

    From April NHS will start looking at the combined HCA and nurses hours to plan for nursing care.
    Try telling a builder, an engineer or a GCSE maths student to add together cm and km together. They are both length measurements but you cannot add them together, first you must CONVERT one to the other THEN add. I really cannot believe that a doctor thinks you do not need to CONVERT one first THEN add. Where was this man educated. Shame on his poor/no understanding of the difference in jobs between a HCA's job and a Nurse's job. He is in the wrong job if he does not understand the different jobs discriptions of nurses and carers.

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  • --- OR try telling a primary school student to add together cm and km without converting first.

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  • the man is clueless , he has never worked on a ward for a 14 hour shift =telling us we are all lazy and are well staffed just shows his ignorance- he would say that because employing people costs money

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  • Healthcare safety branch! Or perhaps performance judging cover up and we will still throw you to the wolves bureau. Send those 5 American consultants home Jeremy we don't want them.

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  • Can't stand to look at that stupid mans face!

    We have electronic systems in my hospital. I can have up to 14 patients to myself on a night shift. Funnily enough the electronic system doesn't help me much if/when my any of my 14 patients starts to deteriorate, or needs PRN pain medications or intravenous antibiotics, or help with repositioning, to the toilet or with personal care. We need more staff not more computers!!!

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  • Earth calling Hunt. Please report to ground control. Nope sorry remembered ground control have all been sacked for performance related issues related to having no staff and quality equipment for cleaning and maintaining cheap stuff properly - now that's lean 😅

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