Safe Staffing Levels

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2007 Health Care Service Group Conference
24 April 2007

Conference notes the recurring theme in both the literature and the media of shortages of Registered Nursing Staff, appropriate skill mix and overall staffing levels and believes that the recent financial crisis has exposed the extent to which the NHS relies upon agency staff, bank staff and overtime – often unpaid – to carry out the fundamental care of patients.

Conference also notes that Modernising Nursing Careers actively encourages nurses to take on new evolving roles and responsibilities. This is in order to help meet Government targets for the reduction of waiting lists for consultation, treatment and to improve patient choice.

Conference believes that despite the welcome expansion of nursing staff across the NHS, very few of these new staff have been employed to improve the nursing ratios at the grassroots of nursing – on the wards and in community nursing teams. Instead they have been utilised to extend nursing roles into specialist projects which do not affect levels of staff available for fundamental nursing care. At grassroots level Nurses have always felt safe and appropriate staffing levels/skill mix to be one of the main measures of job satisfaction.

Conference notes that registered staff have an obligation under the Nursing and Midwifery Council’s Code of Conduct to formally raise any concerns they have about patient safety but that this individual obligation takes a great deal of courage to implement when faced with pressures to keep quiet and put up with poor levels of staffing. Low staffing levels lead to low staff morale and create a vicious circle of demoralisation and loss of staff. Staff would feel more confident and more protected in raising their concerns about particular staffing levels if there were nationally agreed minimum staffing levels which had to be adhered to, which should also include recommendations for appropriate numbers of administrative and clerical and ancillary staff.

The aim of nursing is to promote health, restore health, alleviate suffering and prevent illness. An ever-changing political and financial climate is however making this impossible to fully achieve. Research has demonstrated time and time again that the higher the ratio of nurses to patients the better the care outcomes are, including mortality figures.

Conference acknowledges problems associated with establishing universal norms and how they may fail to keep pace with changes in technology, health and professional practice. However, good organisational management would dictate periodic reviews of staffing and skill mix in line with patient need, specific health and safety concerns and national policy changes.

Conference believes that until UNISON launches a high profile public campaign highlighting the importance of maintaining safe staffing levels, the public will remain unaware of the need to increase levels of staffing in the core areas of health service delivery and will continue to be fooled by the smokescreen of government propaganda on the overall increases in staffing across the NHS.

Conference believes that raising these important issues now is vital if we are to prevent the current round of cuts leading to a permanent imposition of unsafe staffing levels across the NHS. As the union representing the whole health care team, UNISON is ideally and uniquely placed to campaign in defence of the whole health care team.

Conference therefore calls on the Service Group Executive to campaign for a long-overdue law requiring NHS employers to set appropriate Nurse Staffing levels in their organisations. This will mean that each trust will be legally accountable for introducing or failing to introduce safe staffing levels for the protection of staff and patients within a national legal framework.

Conference recognises that this is far from being a simple formula that can apply in a one size fits all way to all wards and therefore further calls upon the Health Service Group Executive to:

1)Develop a campaign around Safer Staffing Levels that can adequately cover all the different requirements of maintaining safe staffing and adequate skill mixes in all the different areas of the health service, in conjunction with the relevant sector committees.

2)Develop effective guidelines for branches and regions, which are faced with skill mix reviews.

3)Raise formally our concerns with the Healthcare Commission to identify what role they can play in their assessments to ensure that patient standards and safety is not compromised by inadequate staffing levels.

4)Produce briefing notes for UNISON MPs and MSPs on our proposals, explaining clearly our rationale and the benefit to both staff and patients.