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Hospital safe staffing: no ‘one size fits all’, says regulator

NHS Improvement guidelines urges trusts to take on feedback from children, young people and their families

NHS Improvement guidelines urges trusts to take on feedback from children, young people and their families


Michelle McLoughlin, project chair and chief nurse at Birmingham Women’s
and Children’s NHS Foundation Trust. Picture: Newsteam 

New comprehensive safe nurse staffing guidelines for children and young people’s inpatient wards in acute hospitals in England have been published by NHS Improvement.

The guidelines emphasise there is no ‘one size fits all’ approach, but directs that best practice combines professional judgement with professional standards and benchmarking, the use of an appropriate staffing dependency tool and 'a robust evaluation' of outcomes.

It also urges that trusts should take on feedback from children and families to ensure that the staffing approach is working.

Leadership is crucial

Birmingham Women’s and Children’s NHS Foundation Trust chief nurse Michelle McLoughlin, who was the project's chair, said leadership was crucial.

Ms McLoughlin introduced the guidelines by saying: ‘Our leaders have a complex task at hand to take into account so many factors when planning staffing.

‘From getting the ratios right to considering the impact of the physical environment of the ward, the skill mix, productivity and efficiency of the team, and measuring the quality of the team to develop staffing plans.’

The guidance stipulates that each ward should always have at least two registered children’s nurses on duty, irrespective of its size or layout.

Supervisory capacity

It also reminds directors of nursing of a pivotal recommendation of the 2013 Mid Staffordshire Inquiry report – in that ward nurse managers should operate in a supervisory capacity, and not be office-bound or expected to double up – except in emergencies – as part of the nursing provision on the ward.

The guidance reproduces this section from the inquiry report: ‘[Ward managers] should know about the care plans relating to every patient on his or her ward.

‘They should make themselves visible to patients and staff alike, and be available to discuss concerns with all, including relatives.

‘Critically, they should work alongside staff as a role model and mentor, developing clinical competencies and leadership skills within the team.

‘As a corollary, they would monitor performance and deliver training and/or feedback as appropriate, including a robust annual appraisal.’

Neonatal and emergency care

In addition to this guidance, there are two further resources on safe staffing for neonatal care and for urgent and emergency care.

NHS Improvement executive director of nursing Ruth May said: ‘Safe and sustainable staffing across all health settings is an essential requirement for NHS trusts looking to provide their patients with high-quality care.

‘Our safer staffing improvement resources are based on the National Quality Board’s expectations that to ensure safe, effective, responsive and well-led care on a sustainable basis, trusts should employ the right staff with the right skills in the right place and at the right time.

‘We have worked with clinicians, leading academics, and stakeholders to create these resources, in the expectation that they will support local NHS leaders and their staff deliver compassionate, effective, safe, sustainable high-quality patient care.'

Ms May added that the expert group which had produced the guidelines felt the evidence base was ‘insufficient’ in some areas to support staffing requirements such as ratios.

She argued that ratios do not recognise ‘the diverse nature of departments’ geography, demand profile or complexity’.   

Applied models

She said: ‘The group recognised that in resus and high-dependency areas, the models of care and staffing by the Intensive Care society could be applied.’

RCN general secretary Janet Davies welcomed the new guidelines, but said any safe staffing efforts would fall short if there were not enough nurses to fill the needed positions. 

‘Earlier this year it was revealed that children’s services are falling short of expected standards due to staff shortages and safeguarding failures,’ she said. 

‘All good intentions to provide safe patient care will be wasted if there isn’t the staff available to fill posts. Only by enshrining safe staffing in legislation can patient safety be assured.’

More needs to be done

Ms Davies also said more work needed to be done on safe staffing for different levels of care. 

‘Whether in accident and emergency, neonatal or children services, it is clear that having the right number of people with the right skills impacts on patients outcomes,’ she said. 

‘More work and evidence is clearly needed to fill the existing knowledge gap by defining what safe and effective staffing levels should be for urgent and emergency care.’

‘NHS Improvement should also consider ways to support those working in children and young people community settings in the future.’

Further information


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