Hospital wards should publish ratio of staff to patients every day, say MPs

http://www.theguardian.com/society/2013/sep/18/hospital-wards-ratio-staff-patients-mps

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Hospital wards should publish the ratio of staff to patients daily to ensure that fundamental standards of adequate care are met in the NHS, an influential parliamentary committee recommends.

In its first assessment of the Francis review of the Mid Staffs scandal, in which patients endured appalling care in an NHS hospital, MPs on the health select committee say the health service must change the "culture which tended to prioritise the smooth operation of the system above safe and effective care of patients".

The report says that as an urgent first step, GPs and NHS England – the groups that pay hospitals to treat patients – should force NHS trusts to establish appropriate staffing levels on every ward and then publish daily the ratio of patients to staff.

This goes far beyond the reforms envisaged by ministers and NHS watchdogs.

The government has so far only required the data to be made available when hospitals are periodically inspected by regulators or published twice yearly in staffing surveys. Sir Mike Richards, the new chief inspector of hospitals, has said he would not include staffing levels when deciding which trusts to inspect.

However, MPs say hospitals must make "a clear commitment to open and public accountability for their staffing records" and that a "fundamental requirement of high-quality care was having "adequate levels of both clinically and non-clinically qualified staff in all circumstances".

In May the Safe Staffing Alliance – a collection of academics, nursing and patient groups whose members include the Royal College of Nursing, Unison and the Patients Association – said no ward should have more than eight patients to one registered nurse, plus a nurse in charge on acute surgical and medical wards.

The alliance said its own survey of nurses at 31 English hospitals, in which just under 3,000 people took part, revealed that wards were run with the suggested one-to-eight patients ratio only about 40% of the time.

Stephen Dorrell, chairman of the health select committee, said he was not calling for minimum nurse staffing levels or advocating "nurse numbers to be mandated by Westminster" but that it was important that transparency and openness be paramount in the NHS.

He pointed out that the Salford Royal NHS foundation trust was pioneering such a system, which was designed to reveal when staffing levels fell below the clinically required standard.

Doctors have yet to be convinced. Mark Porter, chairman of the British Medical Association, said that there had to be a recognition that "not every patient was the same".

In an interview with the Guardian Porter said: "A normal birth needs one midwife, a complicated caesarean needs 10 professionals and an operating theatre. There's a subtle difficulty in trying to find a single indicator for a diverse hospital intake. Ward managers are ensuring adequate numbers every day and every night in the NHS and we are running on the edge of criticality. I am against the concept of a single summary number for this."

Such sentiment does not deter Dorrell, a former Tory health secretary. He said that "culture change" in the NHS would mean medical staff "having to get used to being responsible for care. There are too many examples of mediocre care in hospitals that do not put patients safety [at risk] but that go unchallenged."

Instead, the select committee wants to see a way of recording staff concerns in a logbook that could be produced to show that hospitals were aware of their failures. "If an inspector turned up at a hospital and asked to see the records which showed no staff had complained in the last six months I'd think something was wrong," said Dorrell.

Labour'sAndy Burnham, the shadow health secretary, said "one report after another has highlighted the importance of safe staffing levels in the NHS, yet more than 5,000 nursing jobs have already been lost since the election. David Cameron must intervene and provide a guarantee to patients that all hospitals in England will have enough staff to provide safe care."

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