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”
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.
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- Carter Review’s care hours metric ‘too blunt a tool’, warns peer
- Nursing workforce experts question new staffing metric
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.
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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.
- Jeremy Hunt to set out plans to end NHS ‘cover up culture’
- Trusts ranked in new ‘learning from mistakes’ league table
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