Why we don’t need rules on ward staffing levels

Point one:  you may not like this blog.  If this is you, read on.

Point two:  I’m no expert on nurse staffing levels in hospitals.

Cries of “Shame!” go up all over the media on the failure of Professor Don Berwick to state minimum nurse staffing levels on wards.  Here’s why I think he’s right.

  1. Wards differ, and one size won’t fit all.  Why would the same level apply to intensive care as to a stroke, orthopaedic or general medical ward?  I don’t need to be an expert to know that the workload varies.  One number would, as Jeremy Hunt said on World at One, lead to ticking boxes, doing just enough to pass inspections.  Should we have different levels for different wards?  More complexity in rules adds cost and gives more opportunity to get round them.
  2. Rules won’t help the good guys, and won’t stop the bad guys.  Well run hospitals already have enough nurses on every ward.  More statute will simply add a compliance cost to their already thin budgets.  The bad guys will always find ways around them, and the inspectors won’t catch them – these are the experts.
  3. More rules will stifle innovation.  Often this is about doing more or better with less.  If someone finds a way of achieving better outcomes with a lower level of nursing, the rules will stop them.  Did you just mentally take a swing at my face?  Don Berwick keeps saying “Efficiency is a moral imperative”.  We are continually told of the need to think differently, change quickly, transform radically,  all to overcome the looming crisis for the NHS.  Inventing new rules is not going to do that.  At the same time, we don’t have enough nurses and are sucking them out of developing countries who have much greater need than ours.  Moral?
  4. What if tomorrow a Lithuanian study shows how more nurses cut length of stay and save lives?  Some innovations achieve more with more, but try that one on the finance director.  “Oh but we have the regulation nursing levels and no other finance director has read that and where is Lithuania?  Get lost.”

Is it relevant to make comparisons with number of patients per GP?  England average is about 1800, but there’s Stour with 3,000, outstanding patient satisfaction and service.  One number doesn’t fit all – demands vary, what matters is outcomes.

What we need is appropriate levels of nursing on the wards, and those who know how can work it out.  Understanding of demand, capability and skills will come into it, as well as measurement of outcomes.   We need innovation and learning, as the Berwick report stated, all the more because it’s easy to say and not so easy to do.

Harry Longman

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