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Safe staffing still lacks standardised approach, warns Francis

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The chair of the inquiry into the former Mid Staffordshire NHS Foundation Trust has criticised regulator NHS Improvement for failing to produce standardised guidance on safe staffing levels, noting that the judgement of nursing and medical directors was still being relied upon.

Sir Robert Francis QC said “things may not have changed enough” since his 2013 report into care failings at Mid Staffs, which identified a lack of guidance on what constituted safe levels of staffing.

”There is no easily accessible reference to enable a board to decide whether their staffing levels are safe or not”

Sir Robert Francis 

Speaking at the Patient Safety Conference in Manchester on Tuesday, he said hospital bosses were still not in a position to compare staffing levels at their organisation with an agreed standard.

“There is not a document which enables a non-executive board member to compare what is happening in their hospital with a standard, and there is no easily accessible reference to enable a board to decide whether their staffing levels are safe or not,” he said, according to a report by HSJ.

“They are still reliant on professional judgement and in effect trusting their medical director and nursing director,” said Sir Robert.

“What does concern me is that… everyone around the country could have a completely different way of doing [safe staffing] and I do find that slightly difficult,” he later added.

“What does concern me is that… everyone around the country could have a completely different way of doing [safe staffing]”

Sir Robert Francis 

NHS Improvement was tasked with producing guidance after a programme of work on safe staffing guidelines by the National Institute for Health and Care Excellence was controversially stopped in 2015 by the Department of Health - just as NICE was about to release guidance for A&E.

The regulator has been developing documents for a range of settings and recently published its draft “improvement resource” for staffing maternity services.

Sir Robert said the recommendations in the document “essentially followed” guidelines on midwifery staffing levels previously published by NICE.

He told the conference of healthcare leaders that he would have preferred for NICE to continue its programme because it was the “most experienced” organisation at producing evidence-based guidance.

Sir Robert noted that now this work had been taken over by NHSI the “name has been chosen carefully – it is not ‘guidance’, it is an ‘information resource’ even though some of the language looks like guidance”.

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Readers' comments (1)

  • The reason no one will decide on safe patient-nurse ratios is that they know they can't fulfil them. Every hospital is short of trained staff to give safe, effective care. If they had to follow legally binding ratios then most could not function at all. So the status quo continues of stressed out nurses trying to do what they can for their patients while management sit in their offices. And they wonder why nurses are leaving the profession .........

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