The Berwick report tacitly backed staffing ratios and the regulation of healthcare assistants in its recommendations, according to the senior nurse involved in the NHS patient safety review.

However, Elaine Inglesby-Burke said these measures alone will not bring about the culture change the NHS needs.

Chaired by Professor Don Berwick, former health adviser to US president Barack Obama, the review was commissioned by the government in the wake of the Francis report into the care scandal at Mid Staffordshire Foundation Trust.

Ms Inglesby-Burke was one of 15 experts in Professor Berwick’s review team. She is executive nurse at Salford Royal Foundation Trust and also a member of the campaign group the Safe Staffing Alliance.

In an interview with HSJ sister title Nursing Times, Ms Inglesby-Burke said she knew some quarters of the profession were “disappointed” by the Berwick report’s recommendations, which did not explicitly call for mandatory minimum staffing levels or HCA regulation.  

But Ms Inglesby-Burke said the report’s call for the government to ensure all HCAs “meet clear codes of practice as is the case with medical, nursing and other professions” could be interpreted as support for regulation of HCAs.  

She added: “It wouldn’t have to be regulation, but we are going to have to find a system that wraps around HCAs to ensure they’re trained and behave appropriately.”

On staffing ratios, Ms Burke pointed to a note in the report that “calls managers’” attention to research on “proper staffing”.

The research in question – by the Florence Nightingale School of Midwifery at King’s College London – found operating a general medical or surgical acute hospital ward with more than eight patients per registered nurse increased the risk of harm.

“We have been specific: staffing levels should not fall below one to eight in an acute medical or surgical ward. It’s not to be interpreted as ideal or sufficient. Trusts are being asked not to ignore the scientific evidence,” she said.

The report’s main recommendation on staffing is that the National Institute for Health and Care Excellence develop tools for predicting staffing needs for all care settings that can be adjusted in real time, depending on the changing needs of patients.

Ms Inglesby-Burke told Nursing Times the NICE work would predict what staffing levels were needed “beyond safe” across the health service, and would need to be continually developed and updated.

She added: “We had to be clear the report was about safety across the NHS not just about acute hospital wards.

“What people were expecting was we were going to mandate one to eight – but if we had, what about everyone working in mental health, community services, A&E?”

The report also highlighted staffing levels as one of 12 indicators trust boards should look to as early warning signs, along with incident reporting levels and the views of staff and patients.

Ms Inglesby-Burke said it was essential that organisation’s leaders looked at ward or departmental level to get a true picture of the safety of care in their organisation.

Launching his team’s report earlier this week, Professor Berwick said the most important of his recommendations was that the NHS develop a learning culture.

Acknowledging that the “vast majority” of NHS staff “try every day to help to the very best of their abilities”, the report called on the government to invest in training the workforce in quality improvement techniques.

Ms Inglesby-Burke said no “single thing” could make that learning culture happen.

“This report is not a quick fix; there is nothing new in here,” she said. “What the report provides is a set of actions to use moving forward. We don’t have to wait for permission from the government.

“It will be hard work changing the culture of the NHS but it’s absolutely doable,” she said.