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JUN 26/2014

The new NHS safe staffing laws: how will they work?

Staff in UK medical jobs will doubtlessly be aware that legislative changes have recently been introduced by the government to ensure hospital wards are properly manned at all times.

The safe staffing laws were devised as part of the government's response to the Francis Inquiry, conducted in the wake of high-profile care failings at the Mid-Staffordshire NHS Foundation Trust, and are being initiated in recognition of the fact that proper staffing is essential to support safe and effective care provision.

It is intended that the impact of these new laws will be fairly extensive, making it essential that all medical professionals understand the reasons why they are being introduced and the timescale and details involved.

An overview of the laws
The safe staffing laws were announced by the Department of Health in November 2013 in the publication of its full response to the Francis Inquiry. They represent an important step in a planned culture change within the NHS that will make the running of UK hospitals better organised and more transparent.

Taking effect last month, the regulations require all hospitals to publish staffing levels on a ward-by-ward basis - together with the percentage of shifts meeting safe staffing guidelines - in a mandatory process that will be done monthly.

By the end of 2014, it is intended that this will be carried out using models approved independently by the National Institute for Health and Care Excellence (NICE), which is still in the process of finalising its guidance on this key issue.

Draft recommendations focusing on acute hospital wards that provide overnight care for adult patients were issued by NICE earlier this month, noting that registered nurses should not be caring for more than eight patients during the daytime on a regular basis, as this can increase the risk of patient harm.

When the new system is finalised and fully operational, it will require hospitals to be more open and transparent about their staffing levels than ever. Every NHS trust's board is to receive and consider a report on staffing capability and capacity every six months from June 2014, while all wards will need to clearly display information about all staff present and planned on each shift.

Meanwhile, a monthly update on planned and actual staffing levels needs to be considered by boards and made available to the public via the internet, ensuring patients are every bit as informed about this crucial safety data as managers and policymakers.

Why are they being introduced?
Research has demonstrated that staffing levels are inextricably linked to the safety of care provided by hospitals and, furthermore, that staff shortfalls can increase the risk of patient harm and poor quality care, both of which are unacceptable within the NHS.

Inadequate manpower was highlighted in the Francis report as a key cause of the failings seen at Mid-Staffordshire NHS Trust, a state of affairs the government has vowed never to see repeated.

The new laws and guidance are also being introduced at a time when slow progress on recruitment has been highlighted as a concern by a number of industry bodies. A report published by Health Education England earlier this month showed that NHS employers are finding it difficult to recruit qualified nurses at the moment, with around ten per cent of nursing posts in the health service being left vacant.

In its Frontline First report, issued around the time of the government's Francis Inquiry response last year, the Royal College of Nursing (RCN) estimated that nearly 20,000 full-time positions were being left unfilled at that time, partly due to the relative reduction in public service funding in the years since the recession.

The introduction of safe staffing laws will compel hospitals and the government alike to prioritise patient safety over all other administrative and management-related concerns, while potentially creating new jobs for doctors, nurses and other medical staff.

The industry response
The introduction of the laws have been widely welcomed by those within the industry. However, they have also emphasised the need to get the details of the regulations right in order to ensure they are effective.

Jane Cummings, chief nursing officer for NHS England, said: "We must have the right number of staff and the right mix of abilities to meet the needs of patients. Staffing requirements need to be set at the right level from ward to ward, service to service and hospital to hospital. Nationally-set minimum staffing levels won't deliver the flexibility that hospitals need to ensure they provide the high quality of services for their patients."

Meanwhile, RCN chief executive and general secretary Dr Peter Carter said the laws could make "the single biggest impact on improving care in the NHS in recent times", while welcoming future opportunities to provide its own feedback on the exact form future NICE guidance should take.

He explained: "We hope that the final guidelines will focus on preventing failures in care caused by lack of resources, as well as flagging when they have already happened.

"A minimum should not become a default staffing level, and there is more work to do in ensuring staffing levels are safe for every setting." 

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