Analysis
Falling numbers However, questions are being asked about whether all trusts in England will be able to achieve recommended staff levels, given falling employee numbers in the NHS. Since the last election, the nursing and midwifery workforce in England has fallen by 3,000 full-time equivalents to just over 307,000, according to data from the Health and Social Care Information Centre. RCN director of policy Howard Catton says setting safe staffing ratios could help force policymakers to address the issue of shortages. ‘To protect patient care, now is the time for more clearly defined standards. It must be made mandatory for trusts to use established planning tools to ensure there is the right mix and number of staff.’ Guidance on safe staffing levels in the UK is available at tinyurl.com/RCN-stafflevels and details of the RN4CAST study are available at tinyurl.com/rcn4cast Nick Triggle is a freelance writer
References Ball J, Pike G, Griffiths P (2012) RN4CAST Nurse Survey in England. tinyurl.com/RN4CAST-report-2012 Ball J, Murrells T, Rafferty A et al (2013) ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Quality and Safety Journal. tinyurl.com/care-undone Royal College of Nursing (2012) Mandatory Nurse Staffing Levels. tinyurl.com/mand-staff-levels
NURSING MANAGEMENT
Report proposes better integration of hospital and community services iStock
This has been done already in other parts of the world, such as Australia and the US (see panel). However, lack of clarification from government here has not stopped some NHS hospitals in England experimenting with staffing ratios. One such is Salford Royal NHS Foundation Trust, whose managers have accepted the one-to-eight ratio as a minimum. However, they also recognise that many wards require more nurses and, in early summer, Salford Royal wards started displaying the number of staff and the number there should be. The target number is based on an acuity and dependency tool developed by the Association of UK University Hospitals. Salford’s deputy director of nursing Peter Murphy says the system is working well so far. ‘We have a teleconference each morning to determine what staffing is needed and, if there is a shortage, to see if a reallocation of nurses is required.’
Commission argues that major redesign of secondary provision will improve collaboration and patient care, writes Nick Triggle A RADICAL overhaul in hospital management is needed to ensure patients are not passed unnecessarily and wastefully around the care system, according to an expert group. The Future Hospital Commission says that such reorganisation would require greater flexibility from doctors, nurses and other healthcare professionals. It recommends, as a guiding principle, that, unless clinically necessary, patients are not moved once admitted to hospital, which contrasts with the multiple moves people with complex conditions may endure now as they are moved between specialties. The report states that such a system of transfers damages patients’ experiences; it also ‘propagates waste’ and ‘compromises the delivery of co-ordinated care’. The commission says that the emphasis needs to be on bringing care and, consequently, healthcare professionals to patients. To achieve this, its report proposes designing hospitals centred on three hubs: ■■ A medical division, to ensure hospital generalists and specialists work closely together and with partners in the community. ■■ An acute care hub, to improve co-ordination between emergency care, intensive care and other specialties that look after acutely ill patients.
■■ A clinical co-ordination centre to act as an operational command centre for the hospital, taking charge of patient information and care planning. The importance of seven-day working is stressed, with the report arguing that resources should be spread evenly across the week, even if it means services have to operate at 80 per cent capacity. It also proposes that the concept of discharging patients should end, pointing out that people often need further care after they leave hospital. It therefore suggests that care planning should start on admission. This would require greater integration with secondary, community and social care, so hospitals can be seen much more as part of local health systems. Commission lead fellow Tim Evans says: ‘It could mean hospital doctors and nurses running clinics in the community. This is already happening in the best places, and it is fair to say doctors could probably learn from nurses in this respect. The key point is we need to think differently both in and out of hospital.’ Health secretary Jeremy Hunt has backed the report, describing it as ‘bold and refreshing’. But RCN management and leadership forum chair Jane Valle thinks the NHS should proceed with caution. ‘The idea of putting patients first seems obvious, but it doesn’t always happen, so it is helpful to have it set out this way. ‘However, we need a clearer idea about how it can be achieved. Patients may need to be moved for perfectly legitimate reasons. For example, it is widely accepted that patients have better outcomes when they are treated in specialist stroke units, or there could be a situation where someone has to be moved to critical care. ‘We have to be careful how we define what is done for clinical reasons and what is not.’
Find out more For details of the commission and its report, go to www.rcplondon.ac.uk/projects/ future-hospital-commission November 2013 | Volume 20 | Number 7
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 01, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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Falling numbers However, questions are being asked about whether all trusts in England will be able to achieve recommended staff levels, given falling employee numbers in the NHS. Since the last election, the nursing and midwifery workforce in England has fallen by 3,000 full-time equivalents to just over 307,000, according to data from the Health and Social Care Information Centre. RCN director of policy Howard Catton says setting safe staffing ratios could help force policymakers to address the issue of shortages. ‘To protect patient care, now is the time for more clearly defined standards. It must be made mandatory for trusts to use established planning tools to ensure there is the right mix and number of staff.’ Guidance on safe staffing levels in the UK is available at tinyurl.com/RCN-stafflevels and details of the RN4CAST study are available at tinyurl.com/rcn4cast Nick Triggle is a freelance writer
References Ball J, Pike G, Griffiths P (2012) RN4CAST Nurse Survey in England. tinyurl.com/RN4CAST-report-2012 Ball J, Murrells T, Rafferty A et al (2013) ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Quality and Safety Journal. tinyurl.com/care-undone Royal College of Nursing (2012) Mandatory Nurse Staffing Levels. tinyurl.com/mand-staff-levels
NURSING MANAGEMENT
Report proposes better integration of hospital and community services iStock
This has been done already in other parts of the world, such as Australia and the US (see panel). However, lack of clarification from government here has not stopped some NHS hospitals in England experimenting with staffing ratios. One such is Salford Royal NHS Foundation Trust, whose managers have accepted the one-to-eight ratio as a minimum. However, they also recognise that many wards require more nurses and, in early summer, Salford Royal wards started displaying the number of staff and the number there should be. The target number is based on an acuity and dependency tool developed by the Association of UK University Hospitals. Salford’s deputy director of nursing Peter Murphy says the system is working well so far. ‘We have a teleconference each morning to determine what staffing is needed and, if there is a shortage, to see if a reallocation of nurses is required.’
Commission argues that major redesign of secondary provision will improve collaboration and patient care, writes Nick Triggle A RADICAL overhaul in hospital management is needed to ensure patients are not passed unnecessarily and wastefully around the care system, according to an expert group. The Future Hospital Commission says that such reorganisation would require greater flexibility from doctors, nurses and other healthcare professionals. It recommends, as a guiding principle, that, unless clinically necessary, patients are not moved once admitted to hospital, which contrasts with the multiple moves people with complex conditions may endure now as they are moved between specialties. The report states that such a system of transfers damages patients’ experiences; it also ‘propagates waste’ and ‘compromises the delivery of co-ordinated care’. The commission says that the emphasis needs to be on bringing care and, consequently, healthcare professionals to patients. To achieve this, its report proposes designing hospitals centred on three hubs: ■■ A medical division, to ensure hospital generalists and specialists work closely together and with partners in the community. ■■ An acute care hub, to improve co-ordination between emergency care, intensive care and other specialties that look after acutely ill patients.
■■ A clinical co-ordination centre to act as an operational command centre for the hospital, taking charge of patient information and care planning. The importance of seven-day working is stressed, with the report arguing that resources should be spread evenly across the week, even if it means services have to operate at 80 per cent capacity. It also proposes that the concept of discharging patients should end, pointing out that people often need further care after they leave hospital. It therefore suggests that care planning should start on admission. This would require greater integration with secondary, community and social care, so hospitals can be seen much more as part of local health systems. Commission lead fellow Tim Evans says: ‘It could mean hospital doctors and nurses running clinics in the community. This is already happening in the best places, and it is fair to say doctors could probably learn from nurses in this respect. The key point is we need to think differently both in and out of hospital.’ Health secretary Jeremy Hunt has backed the report, describing it as ‘bold and refreshing’. But RCN management and leadership forum chair Jane Valle thinks the NHS should proceed with caution. ‘The idea of putting patients first seems obvious, but it doesn’t always happen, so it is helpful to have it set out this way. ‘However, we need a clearer idea about how it can be achieved. Patients may need to be moved for perfectly legitimate reasons. For example, it is widely accepted that patients have better outcomes when they are treated in specialist stroke units, or there could be a situation where someone has to be moved to critical care. ‘We have to be careful how we define what is done for clinical reasons and what is not.’
Find out more For details of the commission and its report, go to www.rcplondon.ac.uk/projects/ future-hospital-commission November 2013 | Volume 20 | Number 7
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 01, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
9
