Trusts were wrong to make ‘trade-offs’ on staffing, Hunt tells nurse leaders

Jeremy Hunt said the government’s new measures on staffing, announced in its response to the Francis report on 19 November, should prevent trusts making similar “trade-offs” in future.

He also acknowledged that it had been a “very difficult year for the NHS”, due to the publicity surrounding the Mid Staffordshire Foundation Trust public inquiry.

In a speech to the chief nursing officer for England’s summit last week, Mr Hunt gave more detail on the government’s response to it, especially on the need to embed a culture of compassion.

He acknowledged that showing compassion was “sometimes harder than it should be” when nurses were busy. He said it was job of nursing directors and other leaders to identify and remove “barriers to compassionate care”.

Mr Hunt also admitted that “for many years” there had been a “decline in nursing numbers”. He said 12 months ago workforce projections showed trusts were intending to lose another 7,000 nurses over the next few years, but they now wanted to recruit an additional 4,000 nurses.

“That’s a very big change, that’s happened as a result of everyone starting to think about the implications of compassionate care,” he told delegates.

His comments echo the views of workforce experts who recently told Nursing Times that the NHS was undergoing a “Francis affect” as trusts sought to recruit more nurses in order to maintain patient safety in the wake of Mid Staffordshire.

“It’s not possible to give… compassionate care unless you have the right numbers of staff on all the different wards,” Mr Hunt told delegates.

The government response to the Francis report included guidance that requires all trusts to publish ward staffing levels each month, starting in April, together with the percentage of shifts considered safely staffed. By the end of 2014 this will be done using models approved by the National Institute for Health and Care Excellence.

Ministers rejected calls for a national minimum staffing level on the basis of varying patient acuity between ward types, but Mr Hunt claimed the idea had been looked at “very carefully and discussed endlessly”.

They opted instead to copy models already used by trusts with strong safety records, such as Salford Royal Foundation Trust. He said mandating trusts to publish ward nursing levels in the same way was an attempt to “make sure that we don’t make false economies on staffing”.

“I have to be honest, that is going to put pressure on hospital finances because hiring more staff is an expensive business,” Mr Hunt said. But he added that some of the previous financial “trade-offs” been made by trusts “have been wrong”.

“In particular, there has been a temptation in some parts of the NHS to reduce nursing levels on geriatric wards,” he said. “We need to make sure there are lines that can’t be crossed.”

Mr Hunt told delegates that he hoped the staffing data combined with other patient safety information, like complaints, would act as an “early warning system” that we would “find out much more quickly than we did in the case of  Mid Staffs if we’ve got a problem with staffing ratios”.

Ruth May, NHS England’s director of nursing for Midland and the East, led the development of the new guidance for boards on staffing. She told the summit it should be seen as a “giant step forward” to “normalise” what is already “business as usual” in some of the best NHS organisations.

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