Hospitals in England told to publish staffing levels

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

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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.

It forms part of the government's response to the public inquiry into the Stafford Hospital scandal.

Ministers have also announced:

Has the government accepted all the recommendations?

The Francis Inquiry made 290 recommendations in total. The government has claimed it has accepted all but nine of them.

Those not taken forward include the call for the regulators Monitor and the Care Quality Commission to be merged.

This was never likely to happen as both organisations had recently been given extra responsibilities and undergone changes under the reforms to the NHS made earlier this year.

But of the 281 recommendations the government says have been met, one in four have not been accepted in full.

For example, the inquiry called for a system of registration for healthcare assistants, but the care certificate being introduced falls short of that.

Meanwhile, the inquiry wanted the duty of candour to apply to individuals not just organisations.

Nonetheless, inquiry chair Robert Francis QC said he was happy, describing the government's response as a "comprehensive collection of measures".

• Hospitals will have to produce quarterly reports on how they are handling complaints and clearly set out how patients can raise them.

• A legal duty of candour on organisations to be open and honest about mistakes.

• A criminal offence of wilful neglect to hold staff to account.

• A "fit and proper person's test" so managers who have failed in past will be barred from taking up posts.

• A care certificate to ensure healthcare assistants and social care workers have the right skills and training.

• Every patient should have the names of a responsible consultant and nurse listed above their bed.

Health Secretary Jeremy Hunt said: "Today's measures are a blueprint for restoring trust, reinforcing professional pride in frontline staff and above all giving confidence that they will be given the best and safest care and the way to do that is to be completely open and transparent.

"I believe we can be the safest healthcare system in the world with these changes."

Intense debate

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

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.

But the £13m Francis Inquiry, published at the start of February, and this response from the government, has been aimed at tackling the wider cultural problems in the NHS.

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

In total 290 recommendations were put forward and Mr Hunt said the measures announced address the overwhelming majority of them.

However, 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.

'Open and honest'

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.

Case study

Frank and Janet Robinson

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. "

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 said there was a "very clear link" between staffing and risk.

"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."

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."

And Julie Bailey, of Cure the NHS, the campaign group which helped bring the problems at Stafford Hospital to national attention, said: "We are very disappointed and are not happy at all.

"This is going to create more bureaucracy in the NHS not improve things."

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