Safety by numbers

Government adviser Don Berwick last month called on care providers in England to make sure there are enough staff to deliver care. His report falls short of recommending minimum staffing levels, as some had hoped, but he does demand 'appropriate numbers' to ensure services are safe.

Meanwhile, the RCN is calling for a rethink over the 'friends and family test', suggesting that patients be asked whether they think there are enough staff on the ward instead of whether they would recommend services to others.

Professor Berwick's primary recommendation on staffing is that the National Institute for Health and Care Excellence 'undertake as soon as possible to develop and promulgate guidance based on science and data'.

But care providers in England would be wise to look at what is happening in other UK countries. From next year, health boards in Scotland, for example, must make explicit how they have used a set of government and RCN‑backed tools to estimate their workforce needs, and care providers in Wales can look forward to the launch of similar staffing tools for acute medicine and surgical wards.

The tools in Scotland are to be used at ward level alongside clinical judgement, and clinical and quality indicators. This is right: reducing nursing care to a set of numbers fails to do the profession justice and can be used too easily to drive staffing levels not up, but down to a minimum. It is important that the use of staffing tools do not become a substitute for good nursing leadership.

I would like to illustrate my point by recounting the experience of two friends, who had their second baby in hospital last month. The maternity care, they said, was excellent, but subsequent care on the ward was shocking, with nurses chatting at their station and failing to undertake rounds or ensure that patients had anything to eat or drink.

I wonder how they would respond to the friends and family test, either as the government suggests or as the RCN would like to see it.

About the author

Nick Lipley is the editor of the journal Nursing Management, published 10 times a year by RCN Publishing