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'Address staffing levels to give Francis real legacy'


The long-awaited Francis report’s fundamental purpose was to influence government to change healthcare to ensure the public’s safety. Its purpose was to make sure that a Mid Staffs scandal can never ever happen again.

The question of how many of those 290 recommendations the government will implement remains to be seen - the prime minister is positive about mandatory training for healthcare assistants but lukewarm about regulation; they are trying to “sweep away” the outmoded way the Nursing and Midwifery Council operates but unclear how to resource the increased duties afforded to the regulator for revalidation.

But many of Robert Francis QC’s recommendations will count for nothing while nurses are still overstretched and understaffed.

Now don’t misunderstand me. What happened at Mid Staffs was inhumane, inexcusable treatment of patients. The way patients were spoken to, deprived of food and drink and left in soiled beds was more to do with a lack of compassion than a lack of nurses.

Our understaffing survey featured heavily in the media. This reveals public concern. They know a main factor in the provision of quality care is having adequate staff

But we do know that frequently nurses feel unable to spend time with their patients, talking to them, finding out if they are comfortable and how effective their pain medication is. They are struggling to help their patients get to the toilet, wash or eat, especially on wards with lots of older people who are highly dependent.

Our survey on understaffing in last week’s issue showed 76% of the 595 nurses who responded felt their wards were “dangerously understaffed” “sometimes or always”. This survey featured heavily on the BBC, Sky, ITN and a host of national and local radio stations and newspapers. This reveals public concern. They know one of the key factors in the provision of quality care is having adequate staff.

Mr Francis’ suggestion that NICE tools are used to evidence staffing ratios and numbers is a good start, and let’s hope this leads to a sensible conversation - and more importantly - action.

The evidence Mr Francis heard at the public inquiry, including from the then chief nursing officer for England Dame Christine Beasley, was pretty equivocal on staffing numbers.

She claimed that setting such numbers would mean they would become the “ceiling not the floor”. Fair point, but in some trusts, that would still be an improvement.

Many trusts continue to cut nursing posts and replace qualified nurses with unqualified HCAs. If Francis is to have a real legacy for public protection, then making sure the service gets enough people to do the job - and do it well - should be non-negotiable.

Jenni Middleton, editor Follow me on Twitter @nursingtimesed


Readers' comments (52)


    You must see Slide 8, and research the Nurse Work Index and how that, along with ratios, affects our patient outcomes.

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  • "Our survey on understaffing in last week’s issue showed 76% of the 595 nurses who responded felt their wards were “dangerously understaffed” “sometimes or always”

    Yet Ms Jane Cummings, CNO England, in her response to the Francis Report, published in Nursing Times, does not once mention under-staffing as a concern. Surprise, surprise-not. This woman's ongoing refusal to acknowledge under-staffing as a cause of concern and of poor care is a disgrace. It just shows that her role as CNO is totally useless, as she is clearly a government poodle and wont say anything that might rock the boat and upset her political masters. Time for nurses to have a vote of no-confidence in her I think.

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  • Let's not turn this into a CNO bashing opporunity again.

    This problem has been around since, well I can't remember exactly, but I do remember when the first redundancies of nurses happened in my own Trust.

    When the working time directive led to a reduction in junior doctor hours, nurses were seen as the answer. We expanded our competencies and took on new roles, it was cheaper than employing more doctors you see.

    Then a few years down the line, having allegedly lifted nurses pay to reflect these expanded roles, it became obvious that this wasn't affordable either, so the next step has been a slow and painful erosion of nursing. This has been done by downgrading posts, making nurses redundant as part of restructuring to facilitate this and reducing overall headcount and it has just never stopped.

    Having got away with it then, it has continued and nursing continues to be the target for cost savings. There is a complete lack of understanding that whilst we may be amongst the largest part of the workforce and therefore look like being an expensive resource, we are also one of the most important when it comes to quality of care, safety and compassion - the patient experience.

    So this is not a problem of Ms Cummings making, or indeed Ms Bennett (her counterpart at the DH). It is a problem that has been made by nursing - allowing this to happen at all. I lay the responsibility for much of this at the door of all of the local Directors of Nursing who have not stood up and fought against this and for not having the courage to make sure that those at the very top understand so that they can do the same.

    Sadly, in our fear driven culture, everyone is so keen to present a good image that we undermine our own argument by making sure the problem remains invisible when we should be making it blatantly obvious.

    So next time your Trust has a visit from anyone in one of these top jobs, or from an important inspection agency, don't try and hide the impact that is damaging your ability to give great care, tell it how it is.

    If you don't have the courage to do this, then you really don't have the right to attack anyone for not doing somethinig about it.

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  • What is Ms Cummings role if it is not to stand up for nurses. She is in the position to do it. If people are bashing her it is because she steadfastly refuses to speak up about staff shortages. Nurses on the wards have been stripped of all power and are bullied and victimised if they speak out. Ms Cummings should be speaking for us, she refuses to do so.

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  • try telling this to the chief exec here at rotherham where 750 jobs are to be lost...all in the line of saving money...the francis report means nothing here im afraid!!!

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  • Anon 12 feb 5.03pm

    I have said for a long time Chief Execs have too much power, that one person at the top can make or break a Hospital - as Stafford proved! We also have a Chief exec who plays his own game in our Trust and he is systematically destroying our Hospital.

    Why are they allowed to get away with it?

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  • How much power does the CNO have?
    Can she command trusts to get more nurses?
    Can she demand Nurses to get respect?

    Nures can talk about understaffing until the cows come home, have dinner, get their makeup on and go clubbing and nothing will happen.


    You need to talk to the public. The only way Nurses will be respected and change the NHS is by talking to the public.

    The survey was a good start and the Francis Report is out but Nurses must keep up the momentum.

    Nursing has many, many friends out there. There are people who deeply care about Nurses and Nursing but you need to tell them what is happening because they don't know.

    People will march in London for you. I only know what is happening as I am writing a play about Nursing otherwise I wouldn't know at all.

    Leave the hospitals
    Tell the nation

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  • Our HCA/CSA colleques are not unqualified.
    They have qualifictions such as NVQ Levels 1, 2 or 3 or they may have Open University Qualifications such as the Certificate in Health and Social Care. In the modern age they may hold a higher level of academic qualifiction than qualified nurses who are SRN or RGN level 1. We are going through the profesionalisation of the non-registered health care workforce and we should be justly proud of these fundermental changes.
    We need to all stand together and fight for the highest standards of care and professionalism.

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  • Sarah Stanley | 12-Feb-2013 7:25 pm
    "Why are they allowed to get away with it?" - Probably government puppets!

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  • michael stone

    Part of this, is to allow patients/relatives to see at a glance who is present and doing the work: so, if nurses wear blue, then HCAs should wear a different colour {yellow springs to mind}. To many laymen, everyone 'at the bedside who isn't a doctor' will probably be regarded as 'a nurse' - so a ward with 3 nurses and 3 HCAs would look the same as one with 1 nurse and 5 HCAs.

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