New NICE guidance sets out ‘red flag events’ which warn when nurses in charge of shifts must act immediately to ensure they have enough staff to meet the needs of patients on that ward.
‘Red flag events’ include patients not being provided with basic care such as pain relief or help to visit the bathroom. An appropriate response could be to provide more skilled nurses or increase numbers of staff.
The guidance says having more than eight patients to one nurse on a ward in the day should act as a trigger for checking if care was being compromised.
But NICE stops short of stipulating absolute minimums on staffing numbers.
This latest guidance is designed to help ensure safe and efficient nurse staffing levels on hospital wards that provide overnight care for adult patients in England and is in response to concerns about standards of patient care in the aftermath of the Mid Staffs scandal.
The Francis Inquiry and the Berwick report outlined ways in which the NHS can improve care. Both reports raised the issue of staffing levels, with the Francis report explicitly stating that inadequate staffing levels at Mid Staffordshire led to the poor quality of care. The reports identified that NICE should be the lead organisation in the development of guidance for the NHS on staffing levels.
NICE said that as patients’ needs differ from day to day, there is no single staff number that can be safely and adequately applied across the wide range of wards in the NHS.
The government said the move was a “major step forward”.
The guidelines cover problems with basic care such as delays getting pain relief, not being helped on a visit to the bathroom or not receiving their medication.
Both patients and nurses on wards can raise red flags, which must then be investigated and explanations provided for what has gone wrong.
Professor Gillian Leng, deputy CEO at NICE, said: “Safe staffing is more complex than setting a single ratio. The emphasis should not just be on the available number of staff, it should be on delivering safe patient care and making sure that hospital management and nursing staff are absolutely clear on best practice to do this.”
Currently it is up to hospitals to set their own nurse staffing levels, but NICE was asked to look at the issue by ministers after it was flagged up by the public inquiry into the Stafford Hospital scandal.
Miles Scott, CEO of St George’s Healthcare NHS Trust and chair of the Guideline Development Group, said: “Acute wards see a variety of patients, from appendicitis to broken bones, from young to very old, and each individual has very different needs. This guidance has been trialled in over 100 hospital wards in 14 different hospitals and clearly sets out the factors that must be taken in to account to work out what is the adequate skill level and number of nursing staff required on that particular ward.
“Safe staffing needs to be about ensuring you have the right staff, in the right place, at the right time, to give patients the care they need and deserve.
NICE estimated implementing the guidance could cost £200m - about 5% of the cost of employing nurses on hospital wards - although it said that in the long run it would save money through improvements in care.
Prof Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, said: “We support the principle that staffing on hospital wards should be based on the needs of patients, and welcome NICE’s guidance.
“Staffing isn’t just about numbers. Under our new approach to hospital inspections, we assess whether staffing levels and the skills and training of staff are appropriate in each of the services we inspect.
“We know that staffing levels impact both on safety and on patients’ experience of care. If we judge that staffing levels are impacting adversely on the quality of care, we expect to see improvements.”