New guidelines on NHS staffing levels have been criticised for failing to indicate a minimum nurse-to-patient ratio for high-quality care.
The guidance, issued in July by the National Institute for Health and Care Excellence (NICE), is designed to flag-up dangerously low staff numbers in relation to patient need.
The guidelines say a ratio of one nurse per eight patients should be regarded as a high enough risk to prompt immediate action by management.
Disappointment in NICE’s guidelines is no surprise, as a legal requirement for minimum staff numbers has been long awaited by organisations such as the Royal College of Nursing. Unison members voted overwhelmingly – 92 per cent – in favour of a legally-binding minimum. A separate Unison study into staff levels found it was commonplace to have a nurse-to-patient or midwife-to-patient ratio of 1:8 – the danger limit defined by NICE.
An article on NHSManagers.net by manager Roy Lilley describes the lack of a minimum safe level in NICE’s advice as “ridiculous” and “stupidity”. He makes the point that a sports stadium or a children’s nursery must have a minimum staff ratio enshrined in law, yet a hospital ward, an environment crucial to people’s health or their very survival, does not.
A large amount of research has been published examining hospital patient safety in relation to the number of ward staff, and it is frequently shown that more patients die in hospitals that have fewer nurses working on wards.
NICE guidelines concur with the Department of Health’s view that a blanket minimum staff level cannot be set for the whole of England, as wards have widely varying needs and are best placed to set their own safe staff ratios.
This allows hospitals to be flexible and to adapt to changing demands and staff specialisms, while also bringing in support from healthcare assistants where the skills of specific registered nurses are not necessarily a ward’s greatest requirement.
However, the fact remains that many wards are operating regularly at – or beyond – the danger level identified by NICE.
Surgical error claims have been on the rise so there is a wider interest in how this story evolves over time in the manner in which the NHS address the potential risk to patients.
Will lower numbers of nurses and midwives have more wide ranging effects – time will be a telling factor?