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'Prioritising costs over safety shows Mid Staff lessons are being ignored'


A lack of registered nurses on the ward is almost certainly a familiar and regular experience for many staff working in hospital settings. It is regrettable to be talking about it again, but we must.

This week a hard-hitting report by a well-respected team of nursing researchers has linked those shortages to patient safety and invoked the dreaded name of “Mid Staffs” and the Francis report. The report warned that progress on safe staffing sparked by the infamous care scandal and its ensuing inquiry had been stunted by nurse workforce shortages and financial constraints.

Researchers found wards across the NHS in England were still under-staffed and putting patient lives at risk, despite new policies coming into force after the 2013 Mid Staffs Inquiry.

Worryingly, one in four trusts surveyed for the review reported that the number of patients per registered nurse had exceeded the one to eight ratio recommended by NICE – in its now quietly forgotten acute hospital guidance – on more than 65% of shifts in the past 12 months.

The review was led by Jane Ball, professor of nursing workforce policy at the University of Southampton and a member of the Nursing Times editorial advisory board.

In an interview with Nursing Times, Professor Ball issued two clear warnings that should not be ignored. First, she said: “In a safety critical service like healthcare, you just can’t keep rolling the dice and hoping there will be enough nurses.”

“Demand has continued to outstrip the rise in workforce needed to provide the often-complex care needed in the modern health service”

I completely agree. There have been warnings for years now of a national and international nursing shortage, and vacancy rates for registered staff are hovering around the 40,000 mark in England alone.

Despite an increase in nurses, demand has continued to outstrip the rise in workforce needed to provide the often-complex care needed in the modern health service.

Problems with retention are well documented. As the pressure grows on staff, so more are likely to seek an exit, but leaving those behind even more under the cosh – an ever-decreasing circle if you will. Meanwhile, bursary cuts and Brexit have played their part with reducing the pipeline at the other end.

So far, apart from some fiddling round the edges with the creation of the nursing associate role and nurse apprenticeships, no one has come up with a clear answer on how to get more nurses and nursing staff in general onto wards and into all the other settings that desperately need them.

Professor Ball also said: “Ultimately, staying within budgets and costs have been prioritised over ensuring there’s a sufficient supply of registered nurses to look after patients safely.”

“The findings of this review must be considered and acted upon”

This links directly back to what happened at Mid Staffordshire; it was the ultimate lesson from the failings there and one which should be etched in every senior NHS manager’s mind when thinking about staffing budgets. To lose this learning to history would be beyond careless.

Now, some may say – and many have this week on social media – that it is obvious and that when there are not enough nurses, patients are at higher risk. But it sometimes takes a heavyweight piece of research to pull the evidence together and get the attention it deserves outside of the profession.

Every now and again, something really important happens in the world of nursing workforce policy that should not and cannot be ignored. This feels like one of those moments.

The findings of this review must be considered and acted upon. I for one do not want to be writing about another “Mid Staffs”.


Readers' comments (4)

  • Surely the model has to change? We have a highly developed educated nursing workforce now, covering all sorts of assessment, diagnosis and treatment roles.
    We cannot find, nor afford to pay, sufficient people of that level to safely supervise and care for everyone who comes through our doors.
    We have to utilise supervisory models that ensure all patients have their care co-ordinated by a highly skilled nurse, but more tasks are carried out by junior staff, overseen by the team leader.
    When I trained students provided a huge amount of that care. That is not necessarily the right model but it allowed the trained staff to supervise.
    As with many other professions or vocations at the moment there needs to be better investment in quality training and development for all grades of staff, so care support workers have career progression, and registered nurses have reliable aides.

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  • Rosemary I couldn’t agree more, with pay reflecting education and experience

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  • There is a very real disconnect between the academic and practice when it comes to nurse training. Too many educators are busy fire fighting to teach the basics let alone the fundamental & there is a worrying lack of nurses still practicing in most clinical area’s That have 10 years plus experience.

    Nursing is no longer a career in which there is time to care nor time to get to know the patient. A decrease in financial investment in real terms, retention issues and Student’s not wanting to practice means a real problem for the NHS.

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  • We can afford this if the Government wishes to invest - lack of funding for nursing, bursaries, education, CPD a political choice.

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