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NHS bodies accused of 'watering down' safe staffing guidance


NHS bodies have been accused of “watering down” safe nurse staffing requirements in a bid to save money after they stressed a one to eight nurse-patient ratio was just “a guide”.

A letter sent to nursing directors and other senior managers which highlights the financial pressures the health service is under urges them to “look at staffing in a flexible way”.

Safe staffing guidance issued by the National Institute of Health and Care Excellence last year states a ratio of more than 1:8 on adult hospital wards is a warning sign patients could be at risk of harm.

“We would stress that a 1:8 ratio is a guide not a requirement…It should not be unthinkingly adhered to”

Letter from NHS bodies sent to providers

But the letter from NHS England and other bodies including NICE – described as a “climbdown” by safe staffing campaigners – emphasises this is merely a guideline.

“We would stress that a 1:8 ratio is a guide, not a requirement,” said the document. “It should not be unthinkingly adhered to.”

The letter, entitled “safe staffing and efficiency” is signed by NICE, NHS England, the NHS Trust Development Authority and healthcare regulators the Care Quality Commission and Monitor.

It has been met with alarm by nursing organisations and campaigners including Susan Osborne from the Safe Staffing Alliance, who described the document as “very worrying”.

“It is a climbdown and is just focusing on saving money as opposed to clinical outcomes,” she told Nursing Times.

“[This letter] is a climbdown and is just focusing on saving money as opposed to clinical outcomes”

Susan Osborne

The letter, seen by Nursing Times, said providers should “take a rounded view of staffing” and must be able to show they are “making the best use of resources” as well as offering safe, quality care.

This means taking account of patient acuity and dependency, the time of day, and factors such as the line of sight for those caring for patients, it added.

“In some cases these factors will mean a higher number of nurses per patient, and in other cases it will mean a lower number or different configuration of staff can be justified,” said the letter.

It referred to some trusts that have supplemented ward teams with allied health professionals and said this approach was supported “where appropriately implemented”.

“They’re missing the point by not linking the quality of nursing care to nurse staffing levels,” added Ms Osborne.

She said: “There is no research to support the idea that having an extra physiotherapist  on the ward leads to better nursing care. It is an absolute nonsense.

“This [letter] puts all the pressure on [nursing directors and chief executives] but doesn’t give [them] any additional resources”

Gail Adams

“On the one hand they are saying you can have more nurses, on the other, you can have less nurses and then bring in an AHP so it’s not telling anybody anything other than that they have got to save money.”

In the letter (see attached PDF, top-right), the NHS bodies said they were aware messages on safe staffing and the need to save money “have been seen as contradictory” and there was a need for clarity.

However, they went on to say it was up to NHS trusts to get the balance right by “neither under-staffing nor over-spending”.

Gail Adams, head of nursing at union Unison, said the letter was likely to cause more confusion rather than clarity.

“There is uncertainty and this is going to do nothing to reassure staff,” she said. “This is a watering down and it will make nursing leaders and chief executives feel even more isolated because it puts all the pressure on them but doesn’t give any additional resources.

“It is putting senior managers, clinicians and registrants in an impossible position because it’s asking them to control finances, maintain the quality of care and at the same time staffing levels are up to them. They have none of the support they need in this economic climate.”

NHS England said it did not wish to comment on criticism of the letter.

“We don’t have anything to add to the content of the letter at this stage,” said a spokeswoman.


Readers' comments (7)

  • It is clear that certain areas of ' CARE ' are now being overlooked, when it comes to saving money by having the absolute minimum of staff working on a ward - regardless of the stresses and strains this puts on staff trying their best to cover under impossible circumstances.
    I hear again locally of the death of an ' at risk ' young man in a secure mental health hospital recently,( Devizes ), ( not enough staff to watch him ? ), and of course the recent case of the mother with long term mental health problems, and her baby who simply walked out of hospital and went over the cliff in Bristol.
    It is so sad that we read about similar incidents recurring locally in the South West over the past TWENTY years - time the Coroners got tough I think !

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  • Interesting that an agreed level suddenly changes to a guide not necessarily to be implemented. I agree with flexibility in the use of staffing levels but would agree with the concerns expressed that there is an inference here that 'less will do' either in terms of pure numbers or in terms of skill mix, not a recipe for safe practice or care.

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  • my manager has told us to submit incident forms when short of staff or missing breaks. This is all well and good but haven't enough time to perform patient care let alone spend time completing a lengthy online form

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  • why are we so surprised thesis the sort of thing that happens when finances are tight. Lets just hope that no nurses are harmed while making this %^&*^^U decision

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  • Coroners court can produce inquests that are superficial, slipshod and perfunctory. A Regulation 28 should be ordered where appropriate when there is potential for further deaths to occur because of poor practice.

    There has not been a finding of unlawful death for a person in state custody - detained in a care home, hospital or prison - for 30 years.What does that tell us about this expensive but often inadequate service? Socks…up…pull?

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  • I totally agree with the 6:14pm comment. I think incident forms are a good idea. However, whose got time to complete them as by doing so is putting patient care further at risk.

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  • It does't matter that staff are over stretched, getting no breaks off sick as long as they provide a number for stats genuine care doesn't matter any more!!!!!!
    Just get someone from another area (which is at minimum staffing level too) and put the person in deep end as noone has time to go over report with them or show them where things are in a strange area. Quality care is a dream of the past.

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