Boards could be made to declare staff level is safe

In the Compassion in Practice document, published last week, England’s two top nurses Jane Cummings and Viv Bennett also call for any proposed changes to skill mix to be discussed at board level and for all ward mangers to be given supervisory status. This would mean that they did not count towards staffing on a ward.

One of the report’s authors, Juliet Beal, director of nursing for quality improvement and care at the NHS Commissioning Board, told HSJ they wanted to “steer clear of ratios”, such as registered nurse to occupied bed in a trust. She said these could mask understaffing at ward level.

Instead, boards could be asked to declare publicly they have reviewed staffing levels across the organisation and have assured themselves they can be confident of delivering care that will give good outcomes and patient experience. This could be at the level of ward or individual community settings. The declaration will see trust leaderships offer assurances that they understand the tools used to calculate staffing levels.

An implementation plan for the proposals will be drawn up over the next three months. However, Professor Beal said the commissioning board would encourage clinical commissioning groups to use the recommendations in contracts they draw up.

In future recommendations, such as the requirement to publish staffing levels, could be included into the national contract for all NHS organisations.

At the chief nursing officer’s conference last week, commissioning board chief executive Sir David Nicholson said the board was “completely committed to this strategy’s sense of direction”.

Professor Beal, who has 10 year experience as director of nursing in an acute hospital, said the evidence around supervisory status for nursing mangers was clear but this meant a “senior leader out on the wards” not “sitting in an office”.

She told HSJ staffing levels and the “absolute fundamental importance” of culture had been the issues raised most often by the profession during consultation on the strategy, which was developed in response to concerns about the declining quality of nursing care.

“There are clearly areas [around the country] where there are not appropriate staffing levels on particular wards… Nurses and midwives absolutely recognise their own accountability… but they said one of the most important levers was to have a culture that enabled them to deliver that care.”