MPs urge daily nurse count on wards
Wednesday 18th September 2013, 12:11AM BST.
The number of nurses on duty in every English hospital ward should be collected daily and published to help prevent a repeat of the Stafford hospital scandal, a powerful Commons committee has recommended.
MPs want the information to be collated immediately so it can be analysed but suggested hospitals should also look at posting the figures on wards so patients and families are aware of staffing levels.
The move would help to meet the need for reforms outlined following the public inquiry into the hundreds of needless deaths at Mid Staffordshire NHS Foundation Trust, according to the Commons Health Committee.
Robert Francis QC found t he prioritisation of financial performance over adequate staffing was a significant factor in the poor care at the hospital. His review made 290 sweeping recommendations for healthcare regulators, providers and the Government, which MPs said boiled down to the need for a fundamental change of culture in the NHS.
In a report assessing the main proposals, MPs insisted a “routine culture” of transparency that allows staff freely able to raise everyday concerns, not just major wrongdoing, must be adopted. They warned that formal proceedings, such as disciplinary procedures, professional standards hearings and employment tribunals, are “not appropriate forums for honestly-held concerns” about patient care.
Committee chairman Stephen Dorrell said: “Openness ought to be part of the routine culture of the health and care system. It’s not just a duty of candour that arises when things go wrong.
“If a duty of candour is a form of confession then people will always be defensive. It should be routine, it should apply in all circumstances.”
The wide-ranging report, After Francis: Making a Difference, calls for responsibility for monitoring patient safety data and practice to be handed to the Care Quality Commission.
Following widespread concerns about the use of gagging orders preventing people speaking out publicly about poor care, the committee urged the CQC to write to anyone hit by such a clause to tell them that the terms will not be enforced.
Breaches of planned fundamental standards of patient care in NHS must be treated seriously and investigated thoroughly, it added.
The report highlighted plans by Salford Royal NHS Foundation Trust for a staffing board that would display on the numbers of nursing staff and suggested other hospitals should adopt the same or a similar system.
MPs raised concerns about government proposals to reform nursing training that would mean students seeking NHS funding would be made to spend a year as a health care assistant, claiming it may deter potential recruits.
Mr Dorrell said: “The NHS needs to be an organisation in which an open dialogue about care quality is part of the natural culture of the organisation, not a duty which only arises in cases of service failure.
“Robert Francis made 290 recommendations in his report, but in truth they boil down to just one – that the culture of ‘doing the system’s business’ is pervasive in parts of the NHS and has to change.
“This cultural change will require a system where it is easier to raise a genuine concern about care standards or patient safety than it is not to do so. Many who raise their concerns in the NHS at present risk serious consequences for their employment and professional status.
“But disciplinary procedures, professional conduct hearings and employment tribunals are not the proper place for honestly-held concerns about patient safety and care quality to be aired constructively.
“The NHS standard contract imposes a duty of candour on all NHS providers. This is an essential principle, but it is not adequately understood or applied. It should mean that all providers create a culture which is routinely open both with their patients and their commissioners. The same principle should apply to commissioners so that they are routinely open and accountable to local communities. The Health committee recommended this approach in 2011, and we repeat this recommendation in this report.
“Furthermore, we make it clear that we believe it should be a prime role of the CQC to encourage the development of this culture within care providers, and of NHS England to develop the same culture within commissioners. It is also important to ensure that any new statutory duty of candour is consistent with these broader obligations to patients, commissioners and the wider community.”
Shadow health secretary Andy Burnham called on ministers to implement the recommendations of the Francis Report.
He said: “More than six months after the Francis Report, the Government still has no plan to implement its recommendations.
“After an in-depth, three-year inquiry the time has come to act. Ministers must bring forward plans to implement its recommendations – especially minimum staffing benchmarks.
“One report after another has highlighted the importance of safe staffing levels in the NHS, yet more than 5,000 nursing jobs have already been lost since the election. England’s hospitals must have enough staff to provide safe care this winter.
“This is further proof you can’t trust the Tories with the NHS.”
Health Minister Lord Howe said: “We agree that transparency on staffing numbers and making those numbers visible on the wards are a good thing.
“Patient safety experts agree that safe staff-patient ratios should be set locally. It is not for Whitehall to set one-size-fits-all staffing rules; instead, we are gathering evidence to help hospitals make the right decisions on nurse numbers at a local ward level.
“We have taken swift and strong action as a result of the Francis Inquiry – we have transformed hospital inspections, improved training and civil servants are gaining real and extensive experience of the frontline.”