On 24 June 2014, NHS Choices will be publishing the planned and actual number of nurses on each shift on every inpatient ward in England
Trusts were given until 10 June to submit information on nurse staffing on their wards during May to NHS England. This data will be published on the NHS Choices website.
What do trusts actually have to do?
- Display information about nurses, midwives and care staff deployed for each shift at ward level. The information must be accurate and clearly on show to patients and their families. It should include the planned staffing level and the number of staff actually on duty plus a breakdown of registered and non-registered staff. Display boards should also say who is in charge of a shift and describe the role of each member of the team. They can include useful information such as the significance of different uniforms and job titles.
- Compile a monthly report on staffing to be presented to the trust board each month. These reports should contain details of planned and actual staffing on a shift-by-shift basis for each ward for the previous month. Where staff shortfalls are identified, the report should include the reason for that shortfall, the impact and action taken to address it.
- Publish the monthly report on the trust’s website and upload it to the relevant hospital webpage on NHS Choices. These reports must be accessible and understandable.
- Put together a six-monthly report on staffing capacity and capability following an establishment review. The reports will be presented to the trust board and discussed at public board meetings. The review should use an evidenced-based tool and the report must set out a “realistic expectation of the impact of staffing” drawing on expert professional opinion. The report should cover points including allowances for planned and unplanned leave, skill mix, staffing shortfalls, supervision arrangements, vacancies, sickness rates and plans to finance additional staff. It should also present staffing data alongside key measures of quality and safety. The paper should make clear recommendations to the board.
Where did this initiative come from?
When Robert Francis published his report into care failings at Mid-Staffordshire Foundation trust, many commentators were surprised to find no recommendation for national minimum staffing levels or skills mix ratio. Instead, Mr Francis recommended that staffing levels and skill mix should be made public for each ward.
The government accepted this recommendation and ordered hospital boards to review and publish their staffing levels twice a year:
Exclusive: Nurse staffing levels to be reviewed and made public
The Keogh review also exposed concerns, stating that the NHS has little idea whether nurse staffing levels are safe in England:
Keogh review exposes concerns over nurse staffing levels
The plan was backed by an influential group of MPs:
Hospitals urged to follow Salford’s staffing lead
As part of its response to Francis, the government launched a ‘How to’ guide, which sets out a series of expectations that hospital boards must comply with, including ensuring effective escalation policies are in place so that vacancies on shifts are filled:
Exclusive: Government to order urgent action on staffing levels
NICE was charged with providing guidance on safe staffing for adult inpatient wards:
Francis response: NICE confirms safe staffing guidance programme
How will publishing staffing levels improve patient safety?
In theory, trusts will need to employ an adequate number of nurses to ensure there is a safe number on each ward. However, there are concerns that trusts will find ways around this without having an impact on budgets:
Exclusive: Specialists called onto wards as pressure mounts for safe staffing
Howard Catton, the Royal College of Nursing’s head of policy, has expressed concerns that the current plan differs from what was put forward in November last year: “If there is no consistency and standardisation in those reports, with different metric being used and if it’s being presented in different ways, then how can patients and the public come to a meaningful view about numbers of staff and safety?”:
‘Critical gap’ blights new rules on NHS staffing levels
What are people saying about this initiative?
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