Hunt orders hospitals to publish ward staffing levels every month

NHS trusts will be required to publish figures from next April but health secretary rejects fixed staff-patient ratio

Jeremy Hunt, the health secretary, will on Tuesday introduce monthly mandatory reporting of numbers of staff on hospital wards but will reject a fixed minimum nurse-patient ratio.

Hunt's proposal is in response to the Francis report commissioned in the wake of the Mid Staffordshire scandal, where hundreds of patients died amid appalling failings in care. He will propose that the National Institute for Health and Care Excellence (Nice) be required to draw up a "toolkit" suggesting minimum staffing levels in wards according to the size of ward, acuteness of patient illness, age profile and other factors.

NHS trusts will then be required by law to publish the staffing in each ward – and will be subject to an immediate health inspection by the Care Quality Commission if they are not meeting the guidelines.

The Safe Staffing Alliance, which includes the Royal College of Nursing, Unison and the Patients Association, backs the idea of a fixed staff ratio of no more than eight patients to one nurse.

But Hunt's aides regard support for a fixed ratio as a mistake since they believe it was "Labour's target culture" that led to failures at institutions such as Mid Staffs. The shadow health secretary, Andy Burnham, has not backed a fixed ratio. Proposals for regular publication of ward staffing levels were backed by the health select committee.

The plans come as new figures from Health Education England reveal that NHS hospitals are planning to employ more than 3,700 extra nurses by the end of this financial year, following the Francis report and the focus on safe staffing. The Department of Health regards this increase in the number of nurses as "the Francis effect". Labour claims 6,000 nursing post have been lost since 2010, so an increase of 3,700 will not compensate.

Hunt will tell MPs that from next April, all hospitals will publish staffing levels on a ward by ward basis together with the percentage of shifts meeting safe staffing guidelines. Publication will be mandatory and will be done on every month. By the end of next year this will be done using models approved independently by Nice. It is likely that Robert Francis QC will back Hunt's plans on Tuesday.

Boards will also be required to review the evidence for their staffing numbers in public at least once every six months. A national safety website will publish information relevant to safety in every hospital on a monthly basis so that patients have access to the same information the NHS has.

There will also be guidance, led by the chief nursing officer, Jane Cummings, and the National Quality Board, which will set out how local trusts can work out the right staffing numbers for safe and effective care on their wards and clinical services.

The response to the Francis report also follows a report by Don Berwick, a former adviser to Barack Obama, on patient safety in the NHS. He said: "Fear is toxic to both safety and improvement. To address these issues the system must recognise with clarity and courage the need for wide systemic change and abandon blame as a tool and trust the goodwill and good intentions of the staff." However, Downing Street said at the weekend that wilful malpractice by a nurse could lead to a maximum prison sentence of five years.

Health minister Norman Lamb said: "Professor Berwick's report showed us that, more than anything, safety is about being open and honest. We are determined to see the NHS become a world leader in patient safety – with a safety ethos and level of transparency that matches the airline industry.

"The Francis report is already having an effect, with the NHS planning to hire more than 3,700 extra nurses over coming months. Experts know that the right number of staff varies by ward and by shift, and should be based on evidence. We need transparency on staffing levels, backed up by a strong inspection regime to get better, safer care."

Contributor

Patrick Wintour, political editor

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