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UNISON survey calls for safety in numbers

Legal minimum staff to patient ratio needed to avoid another Mid Staffs, says union

Caroline White

Friday, 19 April 2013

Minimum nurse to patient ratios must be set, if the NHS is to avoid another Mid-Staffs, claims UNISON, the UK’s largest health union.

The Francis Report into the failings at Mid-Staffordshire Foundation Trust recommended the introduction of minimum staff to patient ratios, but the union’s survey of more than 1500 nursing staff, published today, shows that almost half  (45%) of respondents were looking after 8 or more patients on their shift.   
The evidence shows that looking after this number increases the risk of patient harm, says the union. The survey, taken on a typical day in the life of the NHS (5 March), reveals staff under severe strain. One nurse said: “my ward will end up killing someone. That’s how bad it is, and how unsafe”.
Worryingly, almost one in five respondents described care failings in their organisations as being on a par with the Mid Staffordshire Foundation Trust, a situation described as “unacceptable” by Gail Adams, the union’s head of nursing, and Ann Moses, chair of its Nursing and Midwifery Committee, in the foreword to the report.   

The union has pledged to share details of any hospitals named as having failings on a par with Mid Staffordshire Foundation Trust with the Care Quality Commission and the Nursing and Midwifery Council.  

Christina McAnea, UNISON Head of Health, said: “The hidden voice in the survey must surely be that of the patient who is not getting the level of care they are entitled to expect. The government cannot escape its responsibilities to the NHS by pointing the finger at staff or managers.”

She added that the situation was getting worse as the impact of spending cuts deepened, with a fall in staffing numbers, including nurses, at a time when demand is rising.  

Almost two thirds of staff said they did not have enough time with each patient, and nearly 60% of respondents said they did not have enough time to deliver safe, dignified and compassionate patient care.

Time constraints were blamed for patients not receiving the care that respondents felt should have been delivered, including reassuring patients, and explaining treatments and diagnosis.  

Other respondents cited missing out on taking patients to the toilet, giving food or drink, helping patients with their mobility, and writing up full and accurate records.

Over 85% of respondents support set minimum nurse-to-patient ratios.

Some staff felt unable to raise concerns. One respondent said: “When I reported an unsafe situation to a manager, the manager told me I was too patient safety oriented.”

And while respondents felt they carried all he responsibility for errors caused by low staffing levels, they had no control over fixing the situation. Many reported bullying tactics to keep staff from reporting understaffing.  

More than half (55.7%) worked overtime and three out of five skipped breaks, the proportions for which increased among respondents working as nurses.

UNISON is calling for the National Institute for Health and Care Excellence (NICE) to begin working with other organisations, including patient bodies, to identify a UK model of nurse-to-patient ratios in all healthcare settings.   

But Sue Covill, director of employment services at the NHS Employers organisation, said that every hospital was different and a ‘one size fits all’ approach would not help patients.

“We believe arbitrary national minimum staffing ratios would limit how hospitals could plan resources in a way that's best for their patients,” she said. “The best decisions can only be made by looking at the healthcare team as a whole, which means addressing the balance between nurses, doctors, support staff and many others.”

Local NHS organisations were best placed to take responsibility for minimum staffing levels and skill mix, she said, adding that it would be better to have a sound evidence base about safe staffing levels before making further decisions. NICE was already in the process of doing just that, she said.

Patient and Nursing Care at Breaking Point - covered responses to questions about a typical day in the life of the NHS – Tuesday 5 March.  

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