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Evidence shows high-calibre nurses are an investment in safety James Smith is critical of June Clark’s argument for mandatory nurse-patient ratios (letters March 25), citing a single study published in the Journal of Advanced Nursing. The study by Schreuders et al found no consistent association between nurse staffing levels and a variety of complications in Western Australian hospitals. While it would be fair to say that unanswered questions remain and not all studies have shown consistent associations with staffing, a number of considered overviews of the evidence as a whole have come to the conclusion that there is an association between nurse staffing levels and safe care, and that the association is likely to be, in part, causal. A single new study with contradictory results does not change this overall picture. Dr Smith rightly points out that improved nurse staffing is potentially costly, and rejects NHS governance by ‘open cheque book’. Decisions about nurse staffing do have to be considered alongside other priorities, and we still need more and better evidence to guide policies and decision making. The current evidence makes it clear enough that the NHS, along with other providers worldwide, cannot treat high-calibre professional nursing as an optional extra and should at least consider the possibility that it is a cost-effective investment for patient safety. Peter Griffiths, chair of health services research, faculty of health sciences, University of Southampton

A CHANCE TO GIVE PEOPLE WITH LEARNING DISABILITIES A VOICE The green paper unveiled last week by care minister Norman Lamb is a first step to legally entitling people with

learning disabilities to comment on, or even challenge, their care. Aptly named No Voice Unheard, No Right Ignored, the consultation paper has been applauded by many in the learning disability sector who see it as a means of encouraging people to exercise their autonomy, rights and choices. But there are critics, including chair of the commons public accounts committee Margaret Hodge who has said it would be ‘too difficult’ for people to dispute decisions (News April 1). People with learning disabilities have spent many years being denied their rights, and although Ms Hodge’s comments are an unhelpful generalisation, it does remind us that some people will require support. Accessible information will need to be made available to ensure people with learning disabilities understand all the facts to make informed decisions, and the guidance of the Mental Capacity

Act will be needed to ensure capacity to consent is present. Learning disability nurses are fully equipped to assist with this, and independent advocates could also be helpful. We have heard too many horror stories where people with learning disabilities have been denied the right to consult on their care. Setting this right in law will make a huge difference to the lives of people with learning disabilities, and I urge all nurses to join the consultation. The 12-week consultation period closes on May 29. For more information go to consultations.dh.gov.uk Stacey Atkinson, senior nurse lecturer, learning disability nursing, University of Huddersfield

REVALIDATION IS A GREAT IDEA, BUT WHAT RESOURCES WILL SUPPORT IT? I welcome revalidation and love the film at rcni.com/workplace/revalidation, which I have shared with my colleagues.

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A chance to give people with learning disabilities a voice.

The green paper unveiled last week by care minister Norman Lamb is a first step to legally entitling people with learning disabilities to comment on, ...
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