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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)

  • It is becoming increasingly necessary for nurses to look directly into the face of what is happening in order to respond rather than just react.
    JH is a Tory through and through, and is acting on behalf of David Cameron. Nothing JH is doing does not have the support of DC.
    Tory ideology is capitalism AND tradition, ie. hierarchy and inequality. In order for that to operate there must be strict limitations and tolerance of empathy or social conscience. The less empathy or conscience, the better it works.
    In order for this to continue mechanisms must support and ensure this approach, ie. marketisation, competition and giving advantage to those who uphold this ideology, and mechanisms to limit the crossover of populations. There are winners and there are losers because they are both necessary for the mechanism to work.
    For us to respond we need to know what the ballpark is and how it is different from the ball park we inhabit as carers. We must respond on our terms but to that which is offered, together.

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  • Spot on the language must be understood, and knowing the practicality of it is just one method to overcome it. The mechanization of nurses to not be aware has began through terms such as mechanistic standardisation, performance, product and process.

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  • Brilliant nurses are starting to see what is going on. Yes I know what many feel about the 5 American consultants and their approach. Just remember when similar consultants pulled out of Canada there was a feeling that it was blamed on the approach of force and not the method - BEWARE of this counter strategy mention- it is in my view both those using this approach and method that are unable to see straight. Jeremy the lack of staffing and conditions is beyond sense don't use cheap behavioural performance and time in motion answers - remember some nurses have worked on assembly lines and include engineers so we know the nonsense. You only have to look on NHS job sites to see how many quality and data experts they're employing to know how expensive this nonsense pseudo stuff is. Knee-jerk reaction are you really that Tayloristic blind?

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  • Understanding method helps understand ways they can hide problems, understand this and you have the beginning for a solution. BALCM

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  • Hunt seems to consider himself some kind of front line healthcare expert. Never mind what those with first hand experience think. It is very easy to look at the theory or look on from the outside and tell others how to do the job and notice where it goes wrong? eg piles of trolleys and queues of ambulances waiting for care in A&E are far more visible than all the highly skilled and time consuming work going on behind the scenes. It is these former that demotivate staff with all the negatives that accompany this and especially when they are powerless to change the situation or control the inflow of patients requiring their attention.

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  • Talk about 'knee jerk' approach here is an example:
    The hospital I work in, decided to open up a ward a few months before the CQC inspections, but with no staff for this ward, arrangements were made with ward managers to loan some of their staff to this ward to keep it open.
    Opening up this ward prevented the CQC seeing long waiting time in A & E (equals no bad report on that count).
    This knee jerk reaction had and is having a negetive effect on the care and staff on the wards that loan their staff.
    Only yesterday the day staff had to wait 1 hour after their shift was over, as there was only 1 night nurse instead on the two. The other nurse was on loan to this ward with no staff and we could not just get her back, so the Site Manager had to comb the hospital and elsewhere to get a nurse to our ward. After a very hard day working it was no joy to have to give 1 hour freebie again.
    I have never seen so much knee jerk reactions in my life as the management of the NHS together with politics.

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  • Amazing that's so horrendous, how can you be allowed to prepare for staged CQC visits with false imposed staff! I'm shocked surely that kind of practice has to change? How can the public have faith when trusts are allowed to prepare and create false impressions? Is this not called the drama of theatre with acting? So much for the CQC - maybe they should be called staged theatre management... 😄 Rob Pete to pay Paul. P.S wouldn't be surprised if they were staff who didn't complain - at least you have.

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  • Hey guys and girls with the new Carter regime staffing issues become no more or at least it hides the problem so not even the CQC can respond to acknowledge common sense low staff numbers. Not that the CQC necessarily tell you why staffing problems happen!!!! Query CQC get out clause = its a soft data issue we can't help. Or is it called many x grade 7 and above managers worked for NHS and so won't rock the boat.

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  • And now PHSO are recognising the fallacy of behavioural performance ignoring numbers needed to do a job properly so as to understand the nature of detrimental conditions. Is time and motion used also? Is the linguistics of nonsense impinging against the need for staff? Has a nerve been hit?

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