Hospitals to publish staffing levels

Written By Unknown on Selasa, 19 November 2013 | 19.21

19 November 2013 Last updated at 07:07 ET By Nick Triggle Health correspondent, BBC News
Jane Cummings

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Jane Cummings, Chief Nursing Officer, England: "Staffing numbers alone is not enough"

Hospitals in England are to be made to publish monthly details of whether they have enough nurses on their wards.

From April, patients will be able to see the numbers on a new national safety website.

There will be no national minimum staffing standard, but it is likely to include recommended nurse-to-patient ratios for different types of ward.

The move is part of the government's response to the public inquiry into the Stafford Hospital scandal.

Health Secretary Jeremy Hunt is due to address MPs on the issue later.

Nurse leaders and MPs have called for the plan in recent months.

Intense debate

The neglect and abuse at Stafford Hospital between 2005 and 2008, which led to the unnecessary deaths, has already been well documented.

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Case study

Frank and Janet Robinson's son John Moore-Robinson died at Stafford Hospital in 2006.

"John was in a bike accident. He was taken to Mid Staff hospital A&E, which diagnosed him as having bruised ribs and sent him home with painkillers and said after a night's rest he'd be fine. Four hours later he was dead because he had a ruptured spleen.

"We think it happened because of staffing levels and mismanagement right from top to bottom at the Trust.

"On the day John was admitted there were no consultants on duty. He was examined by a very junior doctor with very little experience in A&E medicine.

"It's very difficult to live with the fact that John is dead. But then to keep finding other things out as you go along, it's even worse. "

But the £13m Francis Inquiry, published at the start of February, also revealed wider cultural problems in the NHS.

It accused the NHS of putting corporate self-interest ahead of patients and concluded that failings went from the top to the bottom of the system.

In total 290 recommendations were put forward and Mr Hunt is expected to say most of them have been accepted.

It has already become clear steps such as creating an offence of wilful neglect to cover nurses and doctors and tougher standards for healthcare workers will be introduced.

Mr Hunt is also expected to say that nurses and doctors will have a professional duty to report "near misses" - when patients have been put at risk. At present they only have a duty to report failures and mistakes.

But it is the move to get trusts to be open over staffing levels that is attracting the most intense debate.

It is something the Francis Inquiry said should be looked at and that the Safe Staffing Alliance, which includes organisations such as the Royal College of Nursing (RCN), and Health Select Committee have called for to be introduced.

The government has already asked the National Institute for Health and Care Excellence, the official advisory body for the health service, to look at how safe staffing should be measured.

Evidence suggests different levels of staffing are needed for different wards.

The NHS is yet to decide exactly what the recommended staffing levels will be. But it is likely that, at busy times, elderly care wards will need one nurse to between five and seven patients, and medical and surgical wards will need one nurse to five patients.

Children's wards are likely to need one nurse to every four patients, while intensive care wards would expect to see one-to-one care - according to similar systems already in use in individual hospitals and overseas.

'Open and honest'
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What will the staffing levels be?

The NHS is yet to decide exactly what the recommended staffing levels will be.

They will vary from ward to ward and will depend on what type of patients are on those wards at any one time. Staffing levels will also differ from day shifts to night shifts.

There are various ways of calculating what numbers should be on wards. Some NHS hospitals already use computer-based systems to plan their staffing, while in states in the US and Australia the use of set safe staffing levels have become widespread.

It is likely that, at busy times, elderly care wards will need one nurse to between five and seven patients; in medical and surgical wards about one nurse to five patients; for children's wards one to every four patients; in high dependency wards, one nurse to every two patients; and in intensive care wards, one to one - according to many of the systems already in use.

A new website - expected to be run by NHS England or the Care Quality Commission - is likely to give details on numbers of staff and whether they breach recommended levels.

It will be up and running by April and will include data on staffing levels on each ward, each day. It will be updated monthly.

It is also expected to include information on other indicators, such as death rates and complaints, although these are already publicly available.

Chief Nursing Officer Jane Cummings told the BBC: "We have very clear evidence of a link between appropriate staffing and the outcomes of our patients. Patients and the public are therefore entitled to know that we have the right number of people in place to provide safe, quality care every time."

Health Minister Norman Lamb added safety was about "being open and honest".

"We are determined to see the NHS become a world leader in patient safety - with a safety ethos and level of transparency that matches the airline industry," he said.

But RCN general secretary Peter Carter said the "greater transparency" will raise the issue of whether there are enough staff available.

Official figures show about 3,000 midwifery and nursing posts have been lost since the election - about 1% of the total.

"It is also important that trusts are able to take action if their staffing levels fall below this number," Mr Carter added.

Labour's shadow health secretary Andy Burnham said: "Too many hospitals in England do not have safe staffing levels.

"We have repeatedly warned the government about nurse numbers falling to dangerous levels. This new focus on recruitment is overdue but it shouldn't have taken this long and it won't be enough to repair the damage of three years of falling nurse numbers on David Cameron's watch."


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