Chief nurse says major problems now harder to hide

Speaking after the publication today of Don Berwick report into NHS patient safety, Ms Cumming said it was important trusts had the appropriate staffing level on their wards but called on staff to raise concerns where it was not.

She said staffing would be monitored by the Care Quality Commission’s new chief hospital inspector Sir Mike Richards. As previously reported, staffing levels will not be used routinely to trigger inspections but CQC inspectors will check them during visits.     

“We are in a completely different place to where we were with Mid Staffs. We have moved on and the new model of [CQC] inspection will look at staffing,” she told HSJ. “It is much less likely that they [a hospital] would be able to hide it now.”

However, she acknowledged that under the new CQC model the level of inspection was “not going to go into every ward or trust”.

Ms Cummings said: “This is everybody’s responsibility to support staff to speak out safely. We need to support all staff to be open, transparent and to raise concerns,” she said.

But she reaffirmed the government and NHS England’s opposition to a centrally-set minimum staffing level for hospital wards, despite ongoing pressure from unions and patient groups.

In his report, Professor Berwick had backed the use of “evidence-based acuity tools and scientific principles” to determine safe staffing needs, but stepped back from calling for a mandatory minimum.

His view echoed that made in February by Robert Francis QC in his Mid Staffordshire Foundation Trust public inquiry report, which called for specialty specific staffing levels to be drawn up by the National Institute for Health and Clinical Excellence.

Mr Francis has subsequently called for a rethink on the importance of minimum staffing levels, suggesting they should act as a safety “alarm bell”, as revealed by HSJ’s sister title Nursing Times this week.

However, Ms Cummings said setting a minimum number was the wrong approach, because the level of staff needed would repeatedly change.

Using a ratio such as one nurse to eight patients – as called for by the Safer Staffing Alliance – “risks people just ticking the box” and could encourages the use of temporary or unskilled staff to meet the set level, she said.

She added that a requirement on trusts to use evidence based tools was part of the new national nursing strategy, Compassion in Practice.

The Berwick report also called for a new criminal offence for “wilful or reckless neglect”, which could apply to senior managers, including directors of nursing if they met the criteria.

Ms Cummings told HSJ the report made a clear distinction between people who made a mistake or error, and those who were wilfully reckless in their behaviour.

“That’s a very different place to where we were a few months ago. In the vast majority of cases there are already systems in place to address problems,” she said.

Ms Cummings said it was “absolutely” right for people to be held to account for “wilful or reckless neglect”.