Berwick dashes hopes on minimum staffing levels

The 46 page report says providers should “ensure they have sufficient staff to meet the NHS’s needs now and in the future” and it backed Robert Francis QC’s recommendation that the National Institute for Health Care Excellence develops evidence to enable minimum staffing tools to be devised.

The refusal to support calls for a national minimum staffing level is a blow to unions and campaigners who have argued patients are being put at risk on understaffed wards.

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Understaffing was a significant contributory factor in the poor care at Mid Staffordshire Foundation Trust.

Unveiling the report today, Don Berwick said that instead of a specific number of staff being prescribed real time analytical tools should be in place to allow trusts to examine their staffing levels each day.

Professor Berwick said he hoped the work by NICE would produce a “national formula, locally applied” and which would work in real-time, “moment to moment”.

Although he did not push for a legal minimum staffing level, the former adviser to President Obama said trust boards and healthcare leaders “should take responsibility for ensuring that clinical areas are adequately staffed”.

This information and decisions on staffing should be made public and “easily accessible to patients and carers and accountable to regulators”, the review found.

The review contained a recommendation for how trusts should proceed before NICE developed new tools.

“We call managers’ and senior leaders’ attention to existing research on proper staffing, which includes, but is not limited, to conclusions about ratios,” it said.

“For example, recent work suggests that operating a general medical-surgical hospital ward with fewer than one registered nurse per eight patients, plus the nurse in charge, may increase safety risks substantially.”

The report said this was only one example of the evidence “leaders have a duty to understand and consider when they take actions.”

Health secretary Jeremy Hunt said he agreed with the report’s conclusions and would respond to it alongside the government’s response to the Francis review in October.

“There may be hospitals that are not adequately staffing their wards,” Mr Hunt said.

He said this would be looked at by the new chief inspector of hospitals Sir Mike Richards who would hold trusts to account on their staffing.

The review also calls for enhance training and education of NHS staff to develop a focus on patient safety and quality improvement.

Referring to the scandal at Mid Staffordshire the report says: “NHS staff are not to blame. Neither at Mid Staffordshire, nor more widely, is it scientifically justifiable to blame the staff of the NHS or label them as uncaring, unskilled, or culpable.

“A very few may be exceptions, but the vast majority of staff wish to do a good job, to reduce suffering and to be proud of their work.

“Good people can fail to meet patients’ needs when their working conditions do not provide them with the conditions for success.”