RCN slams NHS Improvement's safe staffing resource for not being a 'binding requirement'

NHS Improvement's draft resource on safe staffing in emergency care fails to recommend specific overall nurse-to-patient ratios

  • NHS Improvement publishes draft resource on safe staffing in emergency care in England
  • It recommends developing models of care, staffing, tools and monitoring
  • No recommendation of specific overall nurse-to-patient ratios
  • RCN calls for a legal duty to make ministers accountable for safe staffing UK-wide

The RCN has reiterated its call for UK-wide safe staffing levels across all settings to be legally binding.

Safe staffing
The RCN has been critical of NHS Improvement's draft resource on staffing in urgent and emergency
care, because it only has the status of advice. Picture: iStock

The college is to consult with members on NHS Improvement's (NHSI) draft improvement resource Safe, sustainable and productive staffing in urgent and emergency care, which covers England.

NHSI makes recommendations for developing models of care, staffing, tools and monitoring, as well as acting on staffing issues and risk.

However, the resource falls short of recommending specific overall nurse-to-patient ratios.

Shortfall of nurses is greatest in emergency departments

An RCN survey of 30,000 UK nurses in September revealed that 55% said shifts did not have the level of nurses planned, while 53% warned that staff shortages are compromising care.

RCN deputy director of nursing Stephanie Aiken said: ‘Our research shows that across hospital settings, the shortfall of nursing staff is greatest in emergency departments (ED). 

‘This demonstrates that there is a clear need for guidance on staffing ED areas safely. However, we’re concerned that this new resource from NHSI on staffing in urgent and emergency care only has the status of advice, rather than being a binding requirement.'

She added: ‘The RCN is calling for a legal duty that makes ministers across the UK accountable for safe staffing levels across all settings.’

'Inappropriate to prescribe definitive nurse-to-patient ratios'

Unison head of health Sara Gorton said: 'This latest resource once again stops short of recommending ratios that would enable nurses, patients and family members to easily identify and report dangerously low staffing levels.

'There must be more emphasis in it on the crucial role unions can play in developing agreements to help employees raise concerns about safe staffing.'

The NHSI resource states that the interdependence of the roles in the multi-professional team has a direct influence on the number and skill mix of the team’s required nursing component.

It also warns that this makes it ‘inappropriate to prescribe definitive nurse-to-patient ratios’, but adds that in workforce planning and review, the required 'nursing establishment' does need to be calculated.

NHSI defines the ‘nursing establishment’ as the number of registered nurses and healthcare support workers who work in a particular department or team.

It cautions about comparing skill mixes which include a ‘substantial contribution from new roles’ which are likely to be used differently by different employers and have differing skills and experience.

Nursing associates could have important future role

NHSI also says the future impact of the nursing associate role in EDs should be considered.

NHS boards should carry out strategic staffing reviews at least annually and consider a staffing review whenever local evidence suggests patient safety might be at risk due to staffing issues, the resource adds.

NHSI has also produced additional staffing improvement resources for neonatal and children and young people.

Right staff with the right skills at the right time

NHSI executive director of nursing Ruth May said: ‘When patients present with urgent and emergency care needs it is important that hospitals have the right staff with the right skills at the right time to ensure that they can respond quickly and effectively. 

‘We are now actively seeking the support and input from NHS staff, patients, managers and the public to help us enhance these improvement resources and let us know how this resource can better serve services in the NHS.’

A consultation on the draft resource closes on 22 December.

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