Opponents of mandatory staffing levels are just plain wrong

When I read Graham Cookson’s Guardian article arguing that introducing minimum nurse staffing levels would be 'a mistake' it made me very cross indeed.

I’m concerned he is boasting that he produced the statistical and economical analysis for the NICE safe staffing guideline. His analysis of costs and benefits to the health service appears to have been determined on the back of a fag packet, underpinned as it is by spurious evidence based on current unsafe staffing levels and high vacancy factors.

He severely underestimates the required financial investment, which should be in the region of £1 billion, not a mid point of £207 million. He also appears to have little understanding of the role of the registered nurse and the concept safe patent care.

The Safe Staffing Alliance is disappointed that ratios of one registered nurse to eight patients at all times, supported by healthcare assistants (HCAs) and a registered nurse as a co-ordinator of care during weekdays, was not mandated as an unsafe staffing level. He states this unsafe ratio was set as a red flag, which is not the case.  In addition, he states there is no comprehensive research evidence and that the mandated levels in Australia and America have proved misguided. Again this is not the case.

NICE failed to recognise the international research that has been undertaken in particular that of Linda Aiken and Magnet Hospitals which proves without a doubt that proper mandated staffing levels do result in harm-free care and a more efficient health care service. The SCOPE for NICE was also silent on mandated levels and it is very clear that NHS England did not want mandated staffing levels to be set in the guidance.

Recent UK research undertaken by Rafferty et al, (Lancet 2013) and Ball et al (BMJ 2014) demonstrate the need for well qualified registered nurses and mandated staffing levels that result in safe patient care. Mr Cookson’s statistical and economic analysis. described in the NICE 'Report on the potential resource implications’, skirts around evidence associated with savings/benefits as there is sufficient information from UK, United States, British Columbia in Canada, and Australia, that shows mortality rates reduce and patient flow increases when there is a safe staffing level. As a result there is better usage of beds and a reduction in medicine errors.

As for HCAs taking on nursing duties at a cut price rate, what planet is Mr Cookson on? He cites Lord Crisp, previously a chief executive for the Department of Health, who left the UK to work in developing countries. Surely we should be aspiring to excellent standards and not subjecting our patients to surgical interventions undertaken by unregistered nurses. We would not wish to be under the knife of an unregistered doctors would we?

I’m outraged that Mr Cookson has denigrated the work of the nursing professions – his view of the nursing role appears to be based on the traditional picture of matrons in white caps.

The NICE guidelines have left the NHS in the same parlous state of unsafe staffing levels, poor efficiency and significant risks associated with patient care. Unless we have a mandated unsafe staffing level of one registered nurse to eight patients we will never know the true cost required to achieve safe staffing levels and the sanctions required to ensure harm free care. Once the investment has been applied, then the savings associated with harm free care and improved bed utilisation will become apparent.


About the author

Susan Osborne is chair of the Safe Staffing Alliance