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| Hospitals need thousands of extra nurses 'or patients' safety will be at risk' | Hospitals need thousands of extra nurses 'or patients' safety will be at risk' |
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| Nurses in hospitals should not have to look after more than eight patients each at any one time, the body that sets NHS standards will urge next week in a move that will add to pressure to end what critics claim is dangerous understaffing. | Nurses in hospitals should not have to look after more than eight patients each at any one time, the body that sets NHS standards will urge next week in a move that will add to pressure to end what critics claim is dangerous understaffing. |
| Responding to concerns about standards of patient care in the aftermath of the Mid Staffs scandal, the National Institute for Health and Care Excellence (Nice) will warn that registered nurses' workloads should not exceed that number because patients' safety could be put at risk. | Responding to concerns about standards of patient care in the aftermath of the Mid Staffs scandal, the National Institute for Health and Care Excellence (Nice) will warn that registered nurses' workloads should not exceed that number because patients' safety could be put at risk. |
| The regulator's intervention will intensify the pressure on hospitals, growing numbers of which are in financial difficulty, to hire more staff to tackle shortages even though many have little spare money. Campaigners on the subject believe at least 20,000 extra nurses are urgently needed at a cost of about £700m. | |
| It will also pose a challenge to ministers, who until now have resisted calls for the NHS to introduce potentially costly mandated minimum staffing levels. | It will also pose a challenge to ministers, who until now have resisted calls for the NHS to introduce potentially costly mandated minimum staffing levels. |
| In drawing up the new guidance, Nice has accepted many of the main arguments put forward by groups such as the Safe Staffing Alliance, which has been campaigning for a ratio of no more than one nurse to eight adult inpatients. | In drawing up the new guidance, Nice has accepted many of the main arguments put forward by groups such as the Safe Staffing Alliance, which has been campaigning for a ratio of no more than one nurse to eight adult inpatients. |
| Nice, a watchdog whose recommendations are supposed to be implemented across the NHS, has spent months examining evidence on the impact staff numbers have on both the quality and the safety of the care patients receive. | |
| Ministers expanded the remit of Nice, which is best known for deciding which drugs represent value for money for the NHS, asking it to produce guidelines on safe staffing levels after last year's Francis report into the Mid Staffs scandal. | |
| The report found understaffing at Stafford hospital, caused by cost-cutting by the trust, had contributed directly to what a previous official inquiry called "appalling care" which led to patients dying and suffering serious harm. | |
| Professor Gillian Leng, Nice's deputy chief executive, is expected to say that hospitals should not see Nice's new recommended 1:8 ratio as a straitjacket, but that failure to observe it and overloading nurses risk harming patients. | Professor Gillian Leng, Nice's deputy chief executive, is expected to say that hospitals should not see Nice's new recommended 1:8 ratio as a straitjacket, but that failure to observe it and overloading nurses risk harming patients. |
| Leng will also tell hospitals that nurses need to be constantly on the alert for "red flag events", such as patients not receiving help to go to the bathroom or not receiving pain medication, which can trigger an immediate need for more nurses on the wards. | Leng will also tell hospitals that nurses need to be constantly on the alert for "red flag events", such as patients not receiving help to go to the bathroom or not receiving pain medication, which can trigger an immediate need for more nurses on the wards. |
| Susan Osborne, the chair of the Safe Staffing Alliance, which includes the Royal College of Nursing (RCN), the health union Unison and the Patients Association, welcomed Nice's move as progress towards ideal staffing levels. Patients could die if it was not observed, she warned. | Susan Osborne, the chair of the Safe Staffing Alliance, which includes the Royal College of Nursing (RCN), the health union Unison and the Patients Association, welcomed Nice's move as progress towards ideal staffing levels. Patients could die if it was not observed, she warned. |
| "A 1:8 ratio still means that the nurse only has seven and a half minutes per patient per hour, which is too little. If it's more than eight then patients won't get fed, care plans won't get written, and nurses can't sit and talk to patients and reassure them about their condition. Care just won't be given to a proper standard, and patients can die," said Osborne, a former director of nursing at St Mary's hospital in west London. | "A 1:8 ratio still means that the nurse only has seven and a half minutes per patient per hour, which is too little. If it's more than eight then patients won't get fed, care plans won't get written, and nurses can't sit and talk to patients and reassure them about their condition. Care just won't be given to a proper standard, and patients can die," said Osborne, a former director of nursing at St Mary's hospital in west London. |
| Eight should be the absolute maximum number of patients a nurse should have to care for but "if you get to that level it's bordering on unsafe care", so ideally the ratio should be 1:4 or 1:6, she added. | Eight should be the absolute maximum number of patients a nurse should have to care for but "if you get to that level it's bordering on unsafe care", so ideally the ratio should be 1:4 or 1:6, she added. |
| The RCN has been warning that the growing number of medically complicated patients in hospital because of the ageing population and lengthening lifespans means that nurses are under "untenable and dangerous" pressures. | |
| In a report last November it estimated that the NHS needed 20,000 more nurses. Some hospitals have up to 16% of their nursing posts vacant, RCN freedom of information requests found. | |
| Many hospitals shed staff from 2010 in an attempt to make the NHS savings target of £20bn by 2015. Although many have begun hiring more nurses since the Francis report, shortages are common and recruitment from overseas countries such as Spain, Portugal and Ireland is increasing. | Many hospitals shed staff from 2010 in an attempt to make the NHS savings target of £20bn by 2015. Although many have begun hiring more nurses since the Francis report, shortages are common and recruitment from overseas countries such as Spain, Portugal and Ireland is increasing. |
| At one trust alone, which recently asked Osborne, to assess its nurse staffing levels, she concluded that it was 100 nurses short of the number required to guarantee safe care for patients and that they would cost £3.5m to recruit. | At one trust alone, which recently asked Osborne, to assess its nurse staffing levels, she concluded that it was 100 nurses short of the number required to guarantee safe care for patients and that they would cost £3.5m to recruit. |
| Many trusts are struggling to recruit nurses locally and are increasingly bringing in staff from overseas. "Since Mid Staffs they have decided to spend money to get more nurses and they are recruiting like crazy but there are still major shortages," said one NHS nursing expert. Trusts unable to find permanent staff are spending hundreds of millions of pounds a year on bank and agency nurses to plug gaps in nursing rotas. | Many trusts are struggling to recruit nurses locally and are increasingly bringing in staff from overseas. "Since Mid Staffs they have decided to spend money to get more nurses and they are recruiting like crazy but there are still major shortages," said one NHS nursing expert. Trusts unable to find permanent staff are spending hundreds of millions of pounds a year on bank and agency nurses to plug gaps in nursing rotas. |
| David Loughton, chief executive of New Cross hospital in Wolverhampton, recently estimated that it would take his trust between 18 months and two and a half years to recruit the number of staff it needed. It planned to bring in 135 extra nurses, so that each shift on each ward would have one extra nurse. | David Loughton, chief executive of New Cross hospital in Wolverhampton, recently estimated that it would take his trust between 18 months and two and a half years to recruit the number of staff it needed. It planned to bring in 135 extra nurses, so that each shift on each ward would have one extra nurse. |
| The Department of Health said: "There are over 5,100 more nurses on our wards since 2010 and in response to the Francis inquiry we have been tough on insisting on compassionate care in our hospitals. | The Department of Health said: "There are over 5,100 more nurses on our wards since 2010 and in response to the Francis inquiry we have been tough on insisting on compassionate care in our hospitals. |
| "We have increased the NHS budget in real terms and are clear that hospitals must balance their books whilst ensuring compassionate quality care for all. We know this can and is being done – safe staffing levels lead to better care and can save the NHS money." | "We have increased the NHS budget in real terms and are clear that hospitals must balance their books whilst ensuring compassionate quality care for all. We know this can and is being done – safe staffing levels lead to better care and can save the NHS money." |
| Labour is likely to challenge the government to say if it will accept the experts' recommendation. The party has recently pointed out that thousands of nursing and other frontline jobs have been cut since the election, while one in six hospitals in England have recently failed inspections on the grounds of inadequate staff numbers. | Labour is likely to challenge the government to say if it will accept the experts' recommendation. The party has recently pointed out that thousands of nursing and other frontline jobs have been cut since the election, while one in six hospitals in England have recently failed inspections on the grounds of inadequate staff numbers. |