Three of the NHS’s most senior nurses have spoken out against the introduction of minimum staffing levels as the profession becomes increasingly divided over the issue ahead of the government’s response to the Francis report.

In a letter published in the Times today the three hospital directors of nursing say they “do not support Whitehall second-guessing what nursing levels should be for each hospital”.

The letter is signed by Eileen Sills of Guys and St Thomas’ Foundation Trust, Katherine Fenton of University College London Hospitals and Flo Panel Coates from Barking, Havering and Redbridge University Hospitals Trust.

It comes in response to calls from the Prime Minister’s Forum on Nursing and Care Quality for the government to introduce a minimum ratio immediately to “bridge the gap” while more detailed guidance is developed.

HSJ’s sister title Nursing Times revealed at the weekend that the forum has urged the government to “take account” of the existing “evidence that a ratio of more than eight patients per registered nurse significantly increases the risk of harm and constitutes a breach inpatient safety”.

Forum members include Janice Stevens, managing director of Health Education West Midlands safety; and Elaine Inglesby-Burke, chief nurse at Salford Royal Foundation Trust and a member of this year’s Berwick review on patient safety.

The Times letter states: “On the eve of the government’s response to Robert Francis’s inquiry into Mid Staffordshire NHS Foundation Trust, we want to urge caution when it comes to mandating minimum staffing numbers and ratios.

“The right numbers of staff will vary depending on the sickness and dependency of the patients and the skill of the staff. It is not something that can be mandated for a whole country.”

HSJ understands NHS England chief nursing officer Jane Cummings is opposed to a minimum staffing level.

The government is expected to publish its full response to the Francis report tomorrow. As revealed at the weekend, it will introduce a new criminal offence for healthcare staff found guilty of willful neglect.

It is also expected to include new guidance on setting safe staffing levels, seen by Nursing Times, which says boards should review staffing levels at least twice a year.

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