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Safe staffing guidelines must not fly under the radar


Two key documents were published for consultation last week, namely draft safe staffing guidance on NHS community teams and mental health providers.

Hopefully, you will have had time to read our two news stories on them, as I think the documents they relate to really are important.

But the point I want to make is that neither document was actively press released by NHS Improvement nor did they appear in the ‘news and alerts’ section of its website. Instead, they were to be found filed under ‘resources’ on the same day as a further nine documents were also published in that section of the website – and at risk of being lost, you might say.

I heard about them because I am glad to say that Professor Mark Radford, the regulator’s fairly new and likeable director of nursing for improvement, heralded their imminent arrival during a workforce session at the chief nursing officer for England’s summit.

“Steps should have been taken to actively highlight and promote these documents”

But they might easily have slipped through the net, when in my view steps should have been taken to not only prevent this but also to actively highlight and promote them.

The documents published last week follow similar draft guidance for acute wards and learning disability services published by NHS Improvement in December. They were not press released either and, worse still, were published in the week before Christmas when, let’s face it, many people’s attention is focused on other things rather than safe staffing guidance.

Of course, I acknowledge that safe staffing is a contentious topic and any guidance on the issue is likely to be heavily scrutinized. But that’s how it should be, as that is the whole point of a consultation process because challenge and debate is how things are strengthened. We are, ultimately, talking about patient safety here.

The origins of the new draft guidance are, of course, shrouded in the murk of politics and controversy. NHS Improvement was given the role of working on them after the job was dramatically taken away from the National Institute for Health and Care Excellence in 2015.

“Challenge and debate is how things are strengthened”

NICE’s work on safe nurse staffing levels, which was called for by no less a figure than Sir Robert Francis, was suspended by NHS England and the Department of Health, just as the institute was on the brink of recommending minimum nurse ratios in accident and emergency departments.

As you may recall, NICE had previously made itself unpopular in some senior circles after recommending the ratio of one nurse to more than eight patients as evidence of the point at which there is increased risk of harm during day shifts on adult acute inpatient wards. The threat of an A&E ratio was seemingly too much for those in the halls of power.

However, in its defence, I believe NHS Improvement has made a promising start in many areas and its senior nurses have been frank and open to scrutiny on topics like agency nursing and workforce retention.

“I believe NHS Improvement has made a promising start in many areas”

And, when challenged on the lack of prominence the guidance had been given by the Nursing Times news team the regulator noted that it was “not NICE” – obvious joke aside – when it came to its public relations approach and was entitled to do things its way.

But I would strongly urge a rethink of its PR strategy on safe staffing guidance. Otherwise, I am left – rightly or wrongly – with that disturbing feeling that someone is trying to hide something from me. After all, we live and work in an age when seemingly everything is viewed as potential news, so why not important new safe staffing guidance?

This should have been an opportunity to leave all that behind and start afresh, with an open and honest approach. But instead, whether on purpose or not, the complete lack of fanfare left me with the suspicion that there was an element of stealth involved.

Guidance on safe staffing and, as a result, patient safety should not be left to slip under the radar, it should be pushed to the top of the news agenda.


Readers' comments (3)

  • Good article - There is a the counter view to Ray Walker, which is an over determination of need to scale and measure at a loss to professional judgement and gain of dependance on economic neo liberal performance. The determination of right numbers and skill, timing and place can not if true be left to cost cutting approaches hidden at a point by the management subjective view of what fixed safety variables should be used nor subjective written variables by fixed safety views by management. Our problem lies also in regulators turning towards economic models of healthcare to what is determined as successful numbers. What we have is arguably a system of measurements towards safety that are apt in manipulating discursive language but also a unsaid need to pressurised staff to perform to quotas rather than potential greater truths that safety is inherently dynamic and demands high demand to resource to cover likely scenarios = meaning it goes beyond simple numbers or measurement of limits. The language of safety seems to be heading away from joint terms of health and towards notions of quality and performance, the problem here is quality based on cheaper notiond behaviour in environment rather than problems of environment and imposition of cost. And who and how is performance and safety measured when performance demands specification of task rather than a greater art of holistic care with the need for better educated staff. We if not careful head towards instead of safety the need to who can perform for less with greater improvement rather than what is better. And Ray do you or Mersey Care only ask those to comment or input who present as agreeable?

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  • Health & safety no longer seems to go together we have well being and safety and quality and safety, all safety and no health. Maybe health and safety tends to lean towards traditional union terms and doesnt lend itself purely to psychological aspects to which MH trusts maybe well too dependant on, in essense in order for safety most may lend to behaviour terms which can for example take away from pure environment understanding for its own merits. When linked to behaviour safety only, we can see cost as cheaper which isnt necessarily right and can make the safety debate all about staff as robots in need of reprogramming for safety rather than the programmers, the environment, cost and other variables involved in events. We in effect change the debate about what management should be doing to one of where the individual staff are responsible for all customer or environment encounters of safety. Blame the worker or newer fallible neo liberal talk of behavioural actions rather than person.

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  • Meanwhile if true - nurse academics (potentially identified as paraversity talkers only) award themselves for arguably influencing debating only & potentially identified liberal management award themselves for cost cutting only. & both feel like they are patronising front liners who do practice action safety & whom according to some will only play by policy and rule only.

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