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A transparent liberty

 

Blog headlines

  • UK’s National Health Service teams up with the Radio Society of Great Britain to improve health and wellbeing
    4 March 2021

    This week's blog is by Paul Devlin, Emergency Care Improvement Support Team (ECIST), NHS England and NHS Improvement.

  • Structuring a PCN Social Prescribing Service for the post COVID world
    25 February 2021

    This week we have a blog by Nick Sharples.

  • Community-Oriented Integrated Care
    18 February 2021

    The blog this week is a short extract from a paper considering an approach primary care networks could use to move towards community-oriented integrated care.

  • Strategy Unit releases opensource model for planning vaccine centre capacity
    11 February 2021

    This week's blog is from The Strategy Unit who are sharing an opensource model to help with vaccine centre capacity planning.

  • Time to talk day
    4 February 2021

    A small conversation about mental health has the power to make a big difference.

  • Supporting Staff: the emergence of ‘long-covid’
    28 January 2021

    As we are now well into a second, or is it now the third, wave of Covid-19 it is becoming apparent that Covid is something we have not experienced before and it has unique implications for staff management. It is not just the possibility that staff may become acutely ill with the virus, but that for some they may go on to develop persistent debilitating symptoms that will affect their ability to go back to work. This article looks at the implications of long-covid for HR and service managers when looking to support health care professionals (HCPs) return to work.

  • Link of the week: Clinically-Led workforce and Activity Redesign (CLEAR)
    21 January 2021

    This week we are sharing a link to the Clinically-Led workforce and Activity Redesign (CLEAR) site that is funded by Health Education England.

  • So much more than an extra pair of hands
    14 January 2021

    The introduction of the additional roles reimbursement scheme for primary care networks has started to grow capacity in general practice to address the unsustainably high workload that has put so much pressure on GPs.

  • Primary Care Networks – how did we get here?
    7 January 2021

    This week we are sharing a blog by PCC’s chairman David Colin-Thomé.

  • A year like no other
    17 December 2020

    On 5 July 1948 the NHS was born, over the last 72 years challenges and changes have been remarkable but the service has probably never been tested as much as in the last nine months. There have previously been numerous re-organisations, multiple changes to hospitals, mental health services and a shift from the family doctor towards more integrated primary care services delivered by a range of professionals. However, rapid transformation of services to embrace digital technologies, and a shift change to work differently has been forced upon all areas of the health service this year.

  • Guest blog: David Hotchin
    11 December 2020

    This week we have a guest blog that was submitted to us by David Hotchin, written by a retired friend....obviously, he's used a little poetic licence.

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

 
 
Friday, 22 November 2013

A transparent liberty

You have to feel sorry for Jane Cummings, the chief nursing officer. She doesn’t make policy, she just goes on the radio to defend it.

Not as sorry, perhaps, as you should feel for those who spend time in the hospitals she described on Radio 4 on Tuesday, which will remain “free” to set the appropriate staffing levels on wards.

The problem with this freedom, which the government also likes to call “local autonomy”, is that it isn’t real.  It means freedom within the resources available, the nationally imposed constraints within which autonomy is framed; the freedom to do what the hospital can afford, the liberty of the prison exercise yard.

So while the chief nursing officer promises “a relentless focus” on compassion and a “forensic level of detail about safety”, she is unable to promise the minimum staffing levels that would make either of these rhetorical commitments real.

She agreed that one nurse to eight patients might be an acceptable ratio in certain cases, but in others, she warned, it might not be enough. If we set a minimum, she argued, it might easily become a maximum.

It is true, of course, that the safe minimum for a general ward would amount to dangerous understaffing if applied to an intensive care unit.

We get that. Minimum means the bottom end of a range, the smallest acceptable number, the point below which we dare not go if we want to avoid another trip to Mid Staffs. It would not be the only number we would ever use.

A nationally agreed figure might not be suitable for every situation but would provide a safety net, something more substantial than a locally qualified “it depends”.

But a clear commitment to minimum staffing is absent from the government’s response to Francis.

Instead of clarity we are promised more transparency. Hospitals will now be obliged to publish their staffing levels so that we can see what we are getting – or not. Expect to see carefully nuanced figures showing a 5% increase in this or a firm commitment to improve that.  Perhaps we will even see nurse to patient ratios published.

What will the numbers tell the public? Not much, unless they add up to a cast-iron guarantee that on the day they or their families need NHS care there will be enough nurses on the shift to provide it.

The other promise made by the chief nursing officer was that in the absence of national minimum staffing levels, local commissioners and regulators will be hard at work deciding what’s appropriate.

Ah, commissioners and regulators. Those freedoms again.

Perspex editor: Julian Patterson

 
Anonymous says:
Nov 22, 2013 09:57 AM
I find it ironic that we can set such staffing ratios when it comes to child care facilities in this country, yet not for the care of our patients on our wards. These patients in many cases are just as vunerable, in need of care, assistance and attention.
Harry Longman
Harry Longman says:
Nov 22, 2013 09:59 AM
I heard the interview and I thought she was right, cool under pressure and sticking to evidence, not tempted like a politician to through a bone to the dog with an easy number to remember. I think she's right to say "it depends", but it's right at the same time to measure outcomes and build the evidence base on "what works". A single number would likely become a maximum, would be gamed in myriad creative ways, and would limit rather than encourage innovation and improvement.
Harry Longman
Harry Longman says:
Nov 22, 2013 10:00 AM
PS sorry I meant "throw" not "through" in that post.
Howard Kenitbee
Howard Kenitbee says:
Nov 22, 2013 10:41 AM
She is right in a way - realistic minimum staffing levels require understanding of the context of a whole range of factors some of which have local variance. We may be in a position in some cases where there has to be a local short term staffing mix strategy but a medium or longer term goal.
The interesting bit will be to see how much engagement there is with front line staff before the figures are nationally or locally decided by the great and the good.
Alison Giraud-Saunders
Alison Giraud-Saunders says:
Nov 22, 2013 10:59 AM
Isn't a good principle here the one about clinical guidelines - that you agree a model and then use professional judgement for variance? For example, you might be able to say that in general a ratio of x:y should work for a surgical ward, but if you have three people with dementia and one with learning disabilities in at the same time, you'd be expected to put more staff on?
pam enderby
pam enderby says:
Nov 22, 2013 11:22 AM
The use of measures of dependency of patients on the ward could be used to identify nursing level needs. Some wards have patients who are unable to eat, drink, move or toilet themselves and require a high level of trained and carer support--- others have fewer of these very dependent patients. Some require more technical and skilled intervention-- others less so. The use of dependency measures would really assist in giving more objective information on staffing levels and skill mix.
Clive Spindley
Clive Spindley says:
Nov 22, 2013 11:41 AM
keep operational & clinical management local, keep technology National - when will the NHS learn and stop zig zaging (& please don't blame the current government, politicians are all the same, their business is power, the business of the NHS & all who work for it is health)
Anonymous says:
Nov 22, 2013 12:04 PM
Having a minimum staffing level would be a terrible and unenforcable idea.

Hospitals would have to monitor wards to make sure they were complient and divert funds away from actual nursing staff. Presumably there would also be penalties for wards that breach implying a national inspection staff.

As said above - local management and standards of care are sufficient.
Anonymous says:
Nov 22, 2013 03:58 PM
It wasn't sufficient at Mid-Staffs unfortunately. There is certainly no quick fix to the staffing issue.
Sarah Bealey
Sarah Bealey says:
Nov 22, 2013 05:03 PM
Lovin' the way the focus is on the hospitals. At least you can monitor when a ward has low staffing levels and patients can see it for themselves. With the transfer to more care closer to home, there has never been a greater need to focus on staffing levels in our community and primary care services. Does anyone know of a good model in use to tell you what's accepted as 'safe' in terms of, say, a district nurse service per 1000 population. I'm not sure one exists and so I agree, there is no quick fix here.
Anonymous says:
Nov 25, 2013 10:01 AM
Until someone reviews the shift patterns that nurses are now working we will continue to have tired, irritable nurses who cannot carry our care in a safe and caring way. We now have 12 hour shifts as the norm in many hospitals. Sometimes these shifts are worked for three days in a row. yes it does give the nurses a good few days of but at what cost. No other job works these hours whilst expecting to respond to changing events. Lorry drivers have to take breaks by law but nurses frequently work these shifts without breaks. My friend is 56 and staffs on a busy stroke unit with minimal staff. She is exhausted doing these shifts but was "encouraged" to accept them. Review these shifts NOW.
Anonymous says:
Nov 25, 2013 11:11 AM
This is an extremely important topic and the posts to it echo and underscore this.
A minimum staffing level is an extemely blunt instrument and one which, as many commentators suggest could become the 'maximum'; the staffing guideline to which hospitals will plan regardless. (q.v. 'Minimum Wage' which has become a yardstick for so many employees regardless of qualification or skill required to do the job (and leading to considerable financial hardship, the requirement for state top-up benefots and political discussion about a 'living wage')).
A 'minimum' staffing level is all about quantity and not quality.
What about the qualifications and experience of staff allocated to wards? A busy ward with only one nurse qualified/licended to dispense drugs with an 'adequate number' of half-qualified/inexperienced assistants is hardly going to cut it.
Ward staffing levels cannot be top-down, centrally imposed. There are too many variales; not least, as one person suggests, leading to an 'encouragement' simply to increase nursing hours to ensure numbers are up - leading to exhausted ward staff and inevitable consequences.
Jane E Ball
Jane E Ball says:
Nov 28, 2013 12:19 PM

Sadly relying on local standards alone is not sufficient – not at Mid Staffs, not at the 14 Trusts reviewed by Keogh, and not on the 107 medical and surgical wards (out of 401 across England) that we surveyed as part of the largest nurse staffing levels study of its kind (that we undertook in 2010-2012). Acute wards that had more than 8 patients per RN on a day shift on general medical and surgical wards, have an increased hospital related mortality. Faced with this evidence, surely we should never let a patient be cared for in such an environment? More than 8 patients per RN constitutes a safety hazard – and needs to be acknowledged as such.
Anonymous says:
Nov 29, 2013 09:03 AM
Has anyone views on the use of AUKUH acuity and staffing tool? Does it have the validity and scientific rigour and what impact it's use has had where it may have been used.