Will patients be harmed by the government’s relentless demand for more efficiency savings in the NHS? Former health minister Norman Lamb believes that the proposed £22 billion savings by 2020 are ‘almost impossible’. And Morecombe Bay investigator Dr Bill Kirkup has warned of disastrous consequences if the NHS focuses on financial savings at the expense of patient safety. Meanwhile Mid Staffs investigator Sir Robert Francis is outraged that NHS England has halted the work on safe staffing levels by the National Institute of Health and Care Excellence. NHS England has instead decided to ‘take over the work’ despite lacking the independent authority and expertise of NICE, and not being able to cope with its current workload. As one senior NHS England manager told MD; ‘I get hundreds of e mails in my in box each day, many of which concern serious governance issues that have arisen out of the confusion of the Health and Social Care Act. I cannot possibly deal with them all – it’s a high risk strategy trying to pick out the urgent concerns.’
The topic was at least debated at the annual Patient Safety Congress (July 6/7) but pressure is being piled onto Directors of Nursing and others to shut up about safe staffing. It shows how little the NHS has changed despite all the rhetoric about encouraging free speech. The government and NHS England knows it cannot safely staff hospitals or indeed GP and community services, so the ‘safest’ political option is to dampen down the evidence to show how importance safe staffing is. A high quality study by NHS England leaked to the Health Service Journal found a significant correlation between the number of nurses on duty in hospitals and 40 indicators of patient safety outcomes such as slips, trips, falls and picking up vital signs such as high temperature, respiratory distress and signs of sepsis. Many hospital inpatients have multiple illnesses and highly complex needs, and can deteriorate rapidly. They require highly skilled staff in sufficient numbers to give them the right care.
The Safe Staffing Alliance is at least prepared to keep shouting and has five important, evidence based messages:
1) Numbers matter when delivering safe and effective care. It is unsafe to care for patients in need of hospital treatment with a ratio of more than eight patients per registered nurse (excluding the nurse in charge) during the day on acute wards. There is evidence that risk of harm to patients is substantially increased when staffing levels fall below this ratio so it must be considered as a ‘red flag’ event and immediate action taken.
2) National standards need to be agreed and enforced. 45% of wards have insufficient staff to meet care needs safely – a situation reflected outside hospitals in the community. Statutory mechanisms should be put in place and guidance issued based on patient dependency, acuity and complexity in different settings.
3) Studies demonstrate that poor care costs more. Employing sufficient nurses and midwives to provide high quality compassionate care, so that patients are treated with dignity and respect, should be viewed as an investment not a cost. Nursing is a 24-hour seven-day-a-week activity and budgets for staffing must be protected to reflect that.
4) There must be genuine transparency over nurse numbers. There is inconsistency in the data recorded with some trusts including the nurse in charge in their nurse/patient ratios. In many areas staff nurses are caring for 10 patients each – more in some cases.
5) Staffing levels based on clear and recognised standards will need investment. Safe, high quality healthcare is expensive and sufficient nurses and midwives need to be trained now to reduce reliance on short term and expensive solutions such as recruiting staff from overseas and reliance on bank and agency staff. There must also be humane jobs available for them when they qualify. Many excellent agency staff started in the NHS but burnt out.
Unless the NHS provides humane and safe staffing levels, it won’t be able to recruit and retain sufficient staff to meet future needs. Junior doctors too are being pressured into dangerous overtime hours, and many are leaving the NHS. The NHS’s greatest asset is its frontline staff, and recruiting them in sufficient numbers to make the job a joy rather than a fast track to burn-out is a no brainer. But tell that to a government demanding immediate and impossible efficiency savings. NHS England needs to start speaking up for NHS staff and NHS funding. As for patients, the safety of NHS care is still hugely variable, propped up by professionalism and good will rather than properly evidenced, planned and resourced safe staffing levels.
MD’s book on how to get the best from the NHS is available here