The Safe Staffing Alliance have made a valuable contribution to the debate about nurse staffing levels by recommending a simple mandatory floor threshold for nurse staffing ratios. Their recommendation of at least one registered nurse to 8 patients is based on compelling research evidence. They have recognised that safe staffing levels in many individual areas will need to be significantly above this threshold and local managers will still need to be held to account for the provision of safe staffing levels for particular circumstances. In the past there have been endless debates about how to measure nursing workload which have frequently paralysed policy makers and prevented the creation of an effective strategy to tackle unsafe staffing levels. Policy makers have continued to stress the need for nurse staffing to be tailored to local circumstances leaving decisions about staffing to local managers . This has allowed some poorly performing trusts to persist in providing wholly unsafe levels of care with impunity. The research cited by the Safe Staffing Alliance also shows the impact of registered nurse numbers on safe levels of care. It is important that we provide adequate levels of registered nurses and do not allow trusts to replace registered nurses with unqualified staff in order to save money. Grade mix is just as important as overall staffing numbers.
The recommendations of the Health Select Committee that Trusts should have to publish figures on nursing staff numbers are a useful first step but do not go far enough.There is insufficient detail about how these proposals would work and on their own they may be insufficient to improve staffing levels. It is not clear how much detail Trusts would be required to provide regarding differential staffing levels in different areas or how much detail would be provided about grade mix. I fear that it would be easy to massage these statistics. Thus it would be far simpler and more effective to support the Safe Staffing Alliance proposals.
A trust logbook of staff concerns recommended by the Health Select Committee would rely on staff feeling safe enough to express their concerns. I am not convinced that current ‘expressions of concern’ policies do enough to protect staff who raise concerns. The SHA have discussed the need for a more effective local patient watchdog. The various arrangements since the demise of Community Health Councils have lacked teeth. I think that a more effective local patient watchdog to whom NHS staff could take concerns in confidence would be a much more useful and effective development following on from the Francis Report.