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Lord Carter to produce ‘clearer guidance’ on nurse staffing levels


Lord Carter of Coles is looking to establish “clearer guidance” on safe staffing levels as part of his review of NHS efficiency, he has said in an interview.

He said his team was working with regulators to produce a “safe range” for staffing at a specialty level, which would help provide “air cover” when trusts faced inspection.

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The Labour peer and a team at the Department of Health have been working with 32 trusts to identify opportunities for savings in workforce management, medicines, estates and procurement – the Review of Operational Productivity in NHS Providers.

“What we’re aiming to do is publish a safe range, so if you took a particular ward you would know you should be producing this many hours of care a day”

Lord Carter

The Department of Health yesterday issued a statement setting out Lord Carter’s estimated potential savings across the NHS, broken down by clinical speciality for the first time.

Last week, regulators contacted trusts to clarify “contradictory messages” around safe staffing levels, and stressed that nurse-patient ratios “should not be unthinkingly adhered to”.

Lord Carter said: “I think what people want, though, is some central air cover on things like staffing levels [and] productivity…. so that if they do take a firm line, they’re supported.

Labour Party

Lord Carter of Coles

“We’re working with the Care Quality Commission, Monitor and the NHS Trust Development Authority to establish a safe range for [nursing] staff,” he told Nursing Times’ sister title Health Service Journal.

He added: “After Mid Staffs there was a sort of rise in staffing and the system told us they would appreciate clearer guidance, but nursing professionals said, ‘We still want discretion.’

“So what we’re aiming to do, and we’ve got first moves on this, is publish a safe range so if you took a particular ward you would know you should be producing this many hours of care a day,” he said.

In effect, the methodology would provide separate guidance for each specialty, to assure trusts their staffing was appropriate in the eyes of the CQC.

This would be a more detailed tool than the 1:8 nurse to patient ratio, which is recommended by the National Institute for Health and Care Excellence in many circumstances, said Lord Carter.

Meanwhile, he said estimates for potential savings had been sent to three trusts in his cohort of 32, and were thought to be realistic.

“I think what people want is some central air cover on things like staffing levels [and] productivity…. so that if they do take a firm line, they’re supported”

Lord Carter

The figures are based on the “huge variations” in clinical costs, infection rates, re-admission rates, litigation payments and device and procedure selection between organisations.

Figures will be sent to the remaining 29 this week, while all acute trusts are due to receive estimates in the next few weeks.

He said the estimated savings figures for the acute sector total £5bn, but he accepted there would be “a lot of room” for negotiation before final targets are finalised in December.

An interim report in June said £5bn could be saved by 2019-20. It is hoped there will be gradual progress towards this, starting in 2016-17.

Some trusts’ potential savings for 2015-16 were already included in their cost improvement plans, so there was little scope for extra savings this year, said Lord Carter.

His review would identify services which were unable to produce savings due to “structural problems”, he said, and make recommendations about where reconfigurations are needed.

However, at present it is unclear when this information will be published.


Readers' comments (3)

  • 1:8 is not enough I have had shifts where as the only trained nurse I have had to completely neglect my other patients because I have one who needs a huge amount of care eventually being transferred to ITU , thankfully I had fantastic HCAs who cared for the other patients and nothing went wrong but things could have been very different. To give good quality care you should always have the back up of another trained nurse .

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  • No amount of "clarification" is going to make this work. Safe staffing levels are a fluid thing, day to day, even hour to hour: they can only be controlled on the ground by the people doing the caring, as they're doing it. To pretend otherwise is admitting that the exercise is only about money and passing CQC's absurd inspections - the realities of safety and quality of care are, by design, excluded.

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  • Its that same old argument isn't it. However now in a current context of 'austerity' and the neoliberal game is well afoot. This is what you voted for or allowed by not voting. If the junior doctors contracts go through everyone can wave goodbye to unsocial hours payments. This isn't scaremongering it is going to happen if everyone says nothing, does nothing and looks the other way.

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