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Leaked NHS England study links nursing numbers and care quality

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A leaked NHS England study has revealed a significant relationship between the number of nurses on duty in hospitals and 40 indicators of patient care and outcomes.

The study examined whether a statistically significant relationship could be shown between nurse staffing levels and patient outcomes over a number of years at University Hospitals Coventry and Warwickshire NHS Trust.

“Our results tell us that there does seem to be a relationship between staffing and safety”

Leaked report

The study was possible because of the high quality of performance data recorded by the trust, as well as using data from the VitalPac observations system, the Datix incident reporting tool and Allocate staffing software. The trust’s chief nurse Mark Radford also contributed to the project.

The study found correlations between nurse staffing and 40 “aspects of patient care”, such as slips, trips and falls, sickness, blood pressure, respiratory rate and temperature. It added that it “does not support the hypothesis that staffing has no causal link with outcomes”.

Commissioned by NHS England chief nurse Jane Cummings, and Midlands and East regional nurse director Ruth May, the report could add further weight to the argument that qualified nurse numbers do affect the quality of patient care.

The report was leaked to Nursing Times’ sister title Health Service Journal yesterday.

Its existence was highlighted in a debate at the Royal College of Nursing’s annual conference in Bournemouth by former RCN president Andrea Spyropoulos.

In response, the RCN’s incoming chief executive and general secretary Janet Davies said the college had been “aware” of the study.

“We are committed to gathering robust evidence on this topic and this report is one part of the process”

NHS England

Details of the study, led by Alison Leary, professor and chair of healthcare and workforce modelling at London South Bank University, have emerged just weeks after NHS England halted work on nurse safe staffing guidance by the National Institute for Health and Care Excellence.

Earlier this month Ms Cummings said NHS England would take forward the work on safe staffing and would not go back on work already carried out by NICE. In a letter to nursing directors she also said it would continue to work with NICE “where appropriate”.

NHS England’s decision was criticised by nursing bodies and Sir Robert Francis, who recommended NICE carry out the work following his inquiry into failures at Stafford Hospital.

The project’s draft final report said: “According to the data in this trust staffing parameters such as establishment and [number of staff] in post appear to have a relationship with outcomes that is significant.

“Our results tell us that there does seem to be a relationship between staffing and safety in about 40 of the aspects of care we looked at,” it said.

“We would need to do more work to see if these things actually caused the effect or if other things we haven’t included are responsible,” said the report.

“However, we can see from the maths we have done that it’s very unlikely that these findings are a fluke or have come about by chance,” it noted.

It added: “It seems likely that a data driven approach would be able to develop a specific optimum staffing model if good quality data were available.”

Among the headline findings was a link between the percentage of registered nurses employed, and the number of slips, trips and falls.

When the percentage of registered nurses was at 50% of the total nursing staff the number of slips, trips and falls were at their highest.

Where qualified nurses made up more than 65-70% of staff, the number of slips, trips and falls on wards reduced by 70% and continued falling the more nurses were employed.

The study found a significant “tipping point”: there was a fall in nausea and vomiting incidents when there were at least 35 registered nurses on a ward.

The authors also found a higher incidence of patient slips, trips and falls alongside wards with a higher number of healthcare support workers. They suggested this could be because patients became more mobile as their health improves.

An NHS England spokesman said: “We are committed to gathering robust evidence on this topic and this report is one part of the process.

“We will study its findings with care over the coming weeks, in addition to other information,” he said.

“The report reinforces the good work that NICE has already done and nothing we are doing changes the NICE guidance that has already been issued,” he added.

  • 2 Comments

Readers' comments (2)

  • Safe staffing numbers are individual to each section of nursing and needs of patients at any one time.
    Therefore, trust the well trained staff to risk assess each day/ week.
    Any blanket decision will alway present overstaffing in some places and grossly unsafe staffing in others.
    Registered nurses are not trusted to make valued judgements,
    Is it our training that is not trusted,? is it our calibre?, are we aiming at being as lazy as possible, so will risk assess to our advantage?. What have we done that our professional judgement has been so downgraded?
    Give each ward/area of nursing a well worked out risk assessment tool, have a standard evaluation of maximum and minimum staffing within that section, and give the nurses working there the ability to vary the level of staffing as the need arises.
    There will always be situations where the planned level of staffing becomes inadequate due to a unforeseen patient need or change in circumstances, or staff sickness, but it should be able to be covered by the next shift, and so not be a day in day out occurrence
    .

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  • michael stone

    I'm confused - is this supposedly a leaked draft report with an expectation that we will all be able to read a finalised version soon, or is this report actually 'pretty-much-the -finished-article' and is its publication being suppressed ?

    Because:

    'The project’s draft final report'

    doesn't really fit with:

    'We will study its findings with care over the coming weeks'

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