Nurses could be given limits on number of patients they care for

A public inquiry into the Stafford Hospital scandal, where hundreds died amid "appalling" failures in care, and a review of nursing ordered by the Prime Minister are considering whether rules should be set which guarantee staffing levels.

These could set out either a maximum number of patients per nurse, or a ceiling for the proportion of healthcare assistants to qualified nurses working on any shift.

The counsel to the Stafford inquiry, which advises its chairman, has said his report "may well conclude" that without such rules, there is an unacceptable risk of too many nursing posts being cut to save money.

The Royal College of Nursing (RCN) is calling for changes amid fears that on some wards - especially those for the elderly - nurses have become dangerously overstretched, with too heavy reliance on cheaper unqualified assistants.

Research has found that on wards for the elderly, the average nurse is caring for at least 11 patients - three more than on units which care for general patients.

In geriatric care, less than half of the staff caring for patients were qualified nurses.

The rest were healthcare assistants - unqualified workers, who are not required to have training, and are supposed to only carry out non-medical tasks, such as washing and feeding.

The study showed that in just four years, the overall proportion of nurses on all wards dropped dramatically - from 65 per cent to 60 per cent by 2009, while reliance on auxiliary staff rose.

Unions last week embarked on a new audit to establish the current figures, amid fears that the trend has steepened since then, as the NHS began an economy drive to save £20bn.

Dr Peter Carter, general secretary of the RCN, said the slide below an average of 65 per cent was "totally unacceptable" and put too many patients at risk.

He said: "The research is clear; when there are not enough registered nurses, what you see is a 'failure to rescue'. Patients deteriorate quickly, and aren't seen in time or develop more complications."

Dr Carter said elderly patients were treated in a way that would not be tolerated among other groups.

"The accepted wisdom in children's nursing is that you need one registered nurse for every four children.

"Yet when it comes to the elderly - a group which often has similar dependency levels - we have got ratios of one nurse to 11 patients," he said.

He said the severe frailty and complex medical conditions of many elderly people was too often ignored.

"Because they are elderly, people assume all they need is a bit of 'TLC' and common sense. In fact, they often have skin like tissue paper, bones like porcelain, and multiple complex conditions."

In evidence to the public inquiry into the Stafford Hospital scandal, due to report later this year, England's Chief Nursing Officer said most wards should not go lower than a 60: 40 ratio of registered nurses to unregistered staff.

Dame Christine Beasley said the decision by Mid Staffordshire Foundation trust to reverse that ratio - with six healthcare assistants for every four nurses on some wards - was "unacceptable".

The inquiry has heard that chronic staff shortages, as the trust attempted to slash £10m from its budget, were one of the main reasons for major failings in care, with hundreds more deaths than would have been expected between 2005 and 2008.

However, the senior nurse, who is due to retire this month, said she had not introduced mandatory nursing levels across the NHS, because she believed there was a risk that "instead of becoming the floor they become the ceiling".

After more than a year's hearings, Tom Kark QC, the counsel to the inquiry has concluded: "The Department of Health should consider providing or endorsing guidance on minimum nurse staffing levels."

After acknowledging some reasons for reluctance, Mr Kark said: "The Inquiry may well conclude that without some form of centrally-approved guidance on staffing levels, an unacceptable risk is created that the pleas of nursing directors may be overborne by management seeking to make cost savings or otherwise interfere with fundamental levels of care."

After considering the advice from his counsel, the public inquiry's chairman Sir Robert Francis will make his own recommendations to the Government later this year.

The overall costs for the NHS would depend on the minimum staffing level agreed, but experts believe such rules would require many hospitals to employ more nurses.

In January, David Cameron ordered an independent review of nursing, amid concerns about standards in the profession.

In what was seen as a damning indictment of care on the wards, he said nurses should be told to check on their patients once an hour.

Sally Brearley, the nurse leading the review, said it will examine "staff numbers and skill mix" as well as the education of nurses and the support given to them.

Yesterday, Mr Cameron indicated that he was determined to tackle a crisis in care for the elderly, with a white paper on social care due to be published later this Spring.

Paul Burstow, the health minister, said that failing to reform a complicated and confused system for care homes and home care would be "dangerously short-sighted".

A study of 30 NHS hospital trusts has found that the chance of a patient dying rises as their nurse's caseload increases.

The research found that the quarter of hospitals with the highest number of patients per nurse had 26 per cent more deaths than the quarter with the lowest caseload.

A survey by Nursing Times found that more than 70 per cent wanted to see the introduction of mandatory ratios either on the numbers of patients per nurse, or the split between nurses and assistants on each ward.

The majority of 400 nurses who took part in the survey in February believed staffing levels had regularly dipped below safe levels in the past 12 months.

One nurse described being left caring for 28 patients on a night shift after one colleague fell sick.


Sourced from The Telegraph, 11th March 2012.