There is a popular notion which is gathering some momentum against anti-privatisation campaigners that the NHS has been consistently starved of essential funds, to make it ‘leaner and fitter’ for privatisation. Financial responsibility has become a central plank of healthcare, as regulators grapple with the issue of what should trigger a “failure regime”. It has become clear through very recent weeks that there needs to be an evidence-based debate about minimum staffing levels in the NHS, whatever your views about the future of English healthcare policy might be.
Victoria Macdonald, a journalist on the Channel 4 blog, explained in a recent article how a ‘perfect storm’ has come together in NHS surpluses, “efficiency savings” and nursing numbers:
“There is an unhappy juxtaposition of figures swirling around at the moment. The first is that the Department of Health is expected to underspent against its 2012-13 expenditure limit by £2.2bn, and none of that is to be carried over for future use. It will instead go back to the Treasury. The second figure is in the NHS workforce survey which shows that last month the NHS lost 800 more nurses.
When the head of the NHS, Sir David Nicholson, announced the need for £20bn savings over a four year period it was promised that these savings would be reinvested on issues such as integrating services and longer term efficiencies Labour claims that Ministers were so distracted by the reorgansation of the NHS that they failed to keep a firm grip on how the savings were being made.”
Baroness Emerton in a House of Lords debate on 11 March 2013 indeed specifically drew attention to the “minimum staffing ratios of registered nurses to non-registered nursing support workers”:
“High-quality and safe care delivery is dependent on nurses who are well prepared, in theory and in practice, with enough time to deliver holistic care with compassion and respect. This is possible only if the workforce plans are such that there are sufficient numbers of registered nurses to supervise the non-registered support workers, as the report clearly shows. Recognising that workforce planning has to be contained within budgetary constraints, it would nevertheless be helpful if minimum staffing ratios of registered nurses to non-registered nursing support workers could be established, along with, I hope, the recommendation that NICE be charged with the responsibility for assisting in this development. I trust that the Government will agree.”
Nicholson in his evidence for the Commons Select Committee for Health on 5 March 2013 argued that:
“Yes. This is a really important issue, I think, and I do not know whether Liz wants to say anything about it. From my perspective, evidence and transparency are the watchwords here, because what Francis says-and I absolutely agree with him-is that we need to use much better what the evidence shows us about what are the right staffing levels for a particular ward, and we need to set that out. We should set out what the minimum staffing level is for each individual ward by using whichever tool that you use, and then we hold the organisation and everybody to account through that.”
Barbara Keeley and Liz Redfern CBE, Director of Nursing at NHS South of England, indeed later had a point of agreement:
“Q279 Barbara Keeley: Was it in place when the 17 that the CQC reported on slipped into having unsafe levels of care? How did that happen? If you were doing what you are doing-I do not know how long you have been doing that-why did we end up with a number of hospitals, and not one or two?
Liz Redfern: It is because of the limitations of looking at something from a distance versus the limitations of the responsibility of the trust board locally. I am able to look at nurse patient ratios for a trust as a measure. That does not tell me how many nurses there are on any particular ward at any one time because that is the responsibility of the trust board. In that sense, those CQC cases were individual wards, individual services. It was not about the whole trust having a problem. That is the difference.
Q280 Barbara Keeley: But who wants to go into a hospital with the knowledge that there are unsafe levels of care on any of its wards? Frankly, you would not want to go near them.
Liz Redfern: No, absolutely not, which is why the local trust needs to be looking at that all of the time and to be on a day to day basis deploying staff in such a way.”
This indeed sets the context for having an evidence-based discussion about what constitutes an adequate nursing staff levels. This debate is important for any regulatory system, which in addition to having public safety as a primary driver, wishes to maintain confidence in, trust in, and the reputation of the nursing profession. Whether #Francis had occurred or not, this is a discussion which would have been had anyway, but it has become all the more urgent for patients and healthcare professionals alike.
