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Royal colleges 'shocked' by regulator chief's staffing levels comments


Royal colleges and workforce experts have severely criticised NHS Improvement chief executive Jim Mackey for his “extraordinary” comments on NHS staffing levels and service standards.

In an interview with Nursing Times’ sister title HSJ on Wednesday, Mr Mackey said 30-40 NHS trusts may have over-recruited staff in recent years and some royal college standards were “unmatchable”, adding: “They’re aspirations.”

He said some organisations had gone too far in trying to meet safe staffing recommendations,including going beyond the 1:8 nurse to patient ratio. He said: “We’ll be saying we can’t afford that, that’s not something that’s justified, there’s no evidence for it, it’s not delivering better outcomes, we expect that to be reined back.”

Colleges said their standards were evidence based guidelines essential for improving care, while safe staffing experts told HSJ Mr Mackey appeared to have misunderstood the clinical evidence on safe staffing and his message was “frightening”.

”This gives completely the wrong message to trusts…by suggesting that finances are more important than patient care”

Janet Davies

Royal College of Nursing chief executive Janet Davies said: “This gives completely the wrong message to trusts, whose boards are responsible for the care, treatment and safety of their patients, by suggesting that finances are more important than patient care.

“These comments are seriously worrying and particularly disappointing as the RCN has been working in partnership with NHS Improvement on the National Quality Board safe staffing guidance refresh.”

She said ignoring evidence based guidance was “foolhardy and places people at unnecessary risk”.

She said going above the 1:8 ratio was an alert and in many wards would be “completely unsafe”, adding: “to treat it as the optimum level is dangerous”.

She said Mr Mackey’s comments risked a return to the days before the 2013 Francis report into care failings at the former Mid Staffordshire Foundation Trust.

”The college wants to see patient care improve, and is shocked at the suggestion that clinical standards can be dismissed as ‘aspirational’”

Neena Modi

“We mustn’t repeat the mistakes of the past, when staff could not properly care for patients because of financially driven cuts. Staff, patients and their families must never again be put in that position.”

Professor Neena Modi, president of the Royal College of Paediatrics and Child Health, said: “The comments by Jim Mackey are quite extraordinary. It would be good to see his justification given the current state of UK population health and patient care.

”Does he believe a 22.7 per cent neonatal rota vacancy rate is acceptable, and that nearly half of paediatric vacancy posts are filled by locums? Has he appreciated that the UK is falling progressively behind the rest of Europe in delivering high quality healthcare and good patient outcomes?

“The college wants to see patient care improve, and is shocked at the suggestion that clinical standards can be dismissed as ‘aspirational’.”

”The analysis behind the 1:8 figure is very much predicated on this being a level at which risk is clearly increased”

Professor Peter Griffiths

She added: “I suggest that rather than accept this shabby suggestion, trusts that are struggling to make ends meet join in the public debate about the appropriate level of funding for UK health services, and the organisational structures that are most cost effective.”

Mr Mackey’s comments drew criticism from safe staffing experts Professor Jane Ball and Professor Peter Griffiths, from Southampton University, who are researching nurse staffing for the Department of Health.

Professor Griffiths said: “It seems to be a clear statement that we need to reduce the number of nurses.

“The analysis behind the 1:8 figure is very much predicated on this being a level at which risk is clearly increased – by definition then, safe staffing lies at a higher level than this. So criticising trusts that go beyond this is frankly frightening and based on a profound misunderstanding of all the evidence and indeed the guidance.”

University of Southampton

Jane Ball

Jane Ball

He added: “It seems we may have learned nothing, or quickly forgotten, the lessons of Mid Staffs and Keogh reviews.”

Professor Ball said: “The NICE guidance seems to have been misunderstood and they were quiet clear that 1:8 isn’t an aspiration but a level that could indicate need for review. It is in no way considered to be the gold standard, it is an amber flag for the driver to pull over and check everything is as it should be.

“Jim Mackey’s comments seem to very much contradict current clinical evidence-based guidance.”

She said it was disappointing NHS Improvement did not have a clear understanding of how well or poorly staffed some trusts were.

She said: “All the evidence suggests that better nurse staffing levels are associated with lower risks of death and adverse events.

“Throughout the last few years the emphasis has been on trusts to work out what patients in their area need and now when they have done that and have worked out what they need they have been told they don’t have responsibility to run their hospitals in the way they consider best for patients. It’s very hard to make sense of that.”


Readers' comments (15)

  • michael stone

    It could get really interesting, if the CQC rows the boat in the opposite direction - and we then have 'regulators at war with each other'.

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  • I was referred to NMC who rejected the mitigating circumstance of "dangerous staffing levels" and "unsafe working environment"
    I referred my manager but NMC were informed by CQC that the levels and the environment were safe.
    However at my appeal against the NMC on June 1st 2016, the Judge at the Leeds High Court disagreed and said " the staffing levels and the working environment placed staff in an intolerable position"
    The NMC had to pay £11,050 for my legal costs.
    Managers, regulators and uncle Tom Cobley and all should take notice of that judge

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  • 1:8 ratios should be illegal in my opinion. I used to work on a MAU where the ratio was 1:6 and even that was completely unsafe a lot of the time.

    The straw that broke the camel's back for me was when I was expected to take an assignment including: 2 patients in respiratory failure on BIPAP; 1 patient with DKA, 1 patient with acute delirium ? cause, 1 end of life patient whom treatment had been withdrawn in the ED and 1 patient with NSTEMI. Needless to say I got all of a 10 minute break during my 13 hour shift, handed my notice in soon after and honestly felt like leaving Nursing altogether.

    Good luck to Ward Nurses because there is no way I could do it again!

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  • Well done to Anonymous who took on the NMC through the courts. Absolutely disgraceful that you were in that situation in the first place. What sort of civilised, first world society treats it's nurses so appallingly? Stories like yours really upset me. I gave up nursing due to the appalling and degrading conditions that i was expected to work in, I hope to go into union work and dedicate my life to making things better for nurses, as I never want anyone to feel or experience what I've had to.

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  • Every ward nurse I speak to at my hospital is stressed because of the massive workload they are expected to endure every shift, there is never a day when the wards have the correct staffing ratios. Staff are missing there breaks, getting off duty late and expected and almost bullied into changing a shift at short notice to cover another shortfall.
    The older nurses can't wait to retire and the younger nurses are leaving the wards to work in clinic, theatre, X Ray, outpatients or anywhere where they think the workload will be less or they are leaving the profession altogether.
    Soon you will not be able to staff the big acute wards at all because of the intolerable conditions that staff have to endure.
    Take heed.

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  • There are a lot of dangerous practices in the NHS that are not properly looked at by the CQC and the NMC. When problems arise due to understaffing, the managers, CQC & NMC are quick to judge Nurses.
    I'm not surprised to see a lot of Nurses leaving the profession. After all, life is to be enjoyed and I chose not to die gradually due to stress.

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  • Well done anonymous. There are many of us who believe the RCN were implicit in working with NHSI in anti-employee approaches and now they're getting nervous? They should know as a union such approaches are used to cut and control staff in austerity. So what you going to do RCN? Nought as usual. Behaviouralism is now what is used to psychologically assault nurses who don't agree sounds like the thought police propaganda machine.

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  • Well done to Anonymous 6.48 pm and 6.49 pm - sounds like the Judge in your particular case could see the bigger picture and the long term implications.
    How horribly stressful for you to have gone through all that, what a worry it must have been, especially if you ended up paying the costs.
    I hope that this is now settled and that the NMC do not decide to mount an appeal - the big organisations seem to be able to dip into a seemingly endless purse until they, 'win'.
    In the past, there 3 nurses who tried to do the right thing with a large PCT - we won the moral case but lost the financial case as we 3 did not have access to the 'public purse'.

    The NHS is expensive to run and costs will get bigger - there needs to be honest dialogue on the future of the NHS, to keep on crossing our fingers and holding our breath will only work for so long. It seems that government policy is to make the NHS fail and collapse - there is need of more Judges to point out to the NMC, (and the government) where the NHS should be heading.

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  • The NHS has been targeted for demolition by Conservative governments for a long, long time and now the results are materialising. Well done to Anon who fought and won and to the wise judge who ensured justice happened. There are organisations like the CQC, to make sure that humane practice (which long term is the most cost-effective way to do things) but they are understaffed and under resourced; there are also policies which ultimately can do nothing else other than deliver deliberate harm, I believe. So much conflict and waste of resources, ludicrous!

    The comment about "the big organisations seeming to be able to dip into a seemingly endless purse" (until the other side loses or drops?) is so true.

    I have personal experience of being persecuted through the courts on false allegations, I believe because I was successful at whistle blowing to the CQC about the provider who was at least in part following unlawful guidance from the PCT/CCG. Circumstantial evidence points to the NHS body being the villain of the piece. And the NHS head honcho got promotion and lots more money. I believe that has to come from central government.

    The Court of Protection judge protected me from the worst of the persecution but failed to protect the patient or to deliver justice to the persecutors who in fairness should have paid all the costs of the case based on false accusations rather than have the costs paid as is traditional, by the patient. Alas the justice system is in a shambles itself and evidence can actually be filtered out by the court officer prior to the hearing. Also it seems quite clear to me that Pathologists and court officers at the Coroners Court and the Police in certain areas are subjected to undue pressure most likely from NHS Management to cover up unacceptable /unlawful behaviour stemming from deliberately bad practise.

    But the people get the government they deserve and how many of us have bothered ourselves in this "democratic" society to write to our local MP and communicate what we think? One paragraph would do it, more if you feel like letting off steam.

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