Safe Staffing Levels and Patient Ratios

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2012 Health Care Service Group Conference
1 January 2012

UNISON Health conference expresses serious concern about employers’ attempts to dilute skill mix and staffing levels as part of cost-cutting within the NHS and the impact which this can have on patient safety.

We note a huge amount of variability in workforce planning, together with scientific evidence demonstrating the value of appropriate skill mixes to patient outcomes, morbidity and mortality. Arguably the main lesson from the Mid Staffordshire Inquiry demonstrates the importance of having the best possible skill mix and staffing levels.

We commend the SGE for initiating a campaign in defence of patient welfare by addressing key aspects of skill mix and staffing levels. We reaffirm our policy position on patient to staff ratios and minimum staffing levels being key to ensuring t he safety of the most vulnerable in our society.

Conference notes that registered nurses have an obligation under the Nursing and Midwifery Council (NMC) code of conduct to formally raise any concerns they have about patient safety. As part of that obligation, nurses must highlight their concerns regarding unsafe nursing levels in every area of patient care. Nurses are witnessing the systematic failure on part of NHS Employers to ensure that appropriate staffing levels and skill mix are paramount in the delivery of patient care, to enable nurses to practice safely.

As a consequence of this failure the NMC have seen a dramatic increase in the number of referrals where nursing staff have failed to provide even basic nursing care and also poor record keeping.

Conference notes that despite this Tory-led Government’s reassurances that the NHS budget and frontline services are being protected, there is overwhelming evidence to dispute this. Investment in the NHS is under sustained attack and staffing levels are bearing the brunt of the financial crisis and a neo-liberal agenda.

Conference further notes that within the UK we have seen the average number of patients per registered nurse rise from 6.9 to 8.4 from 2004 to 2011. These numbers cannot continue to fall without putting patients and nursing staff at considerable risk.

UNISON’s recent survey of over 2000 nurses and midwives found:

a) 75% stated that the number of patients they have treated had gone up

b) 60% reported a drop in staff numbers

c) 64% reported patient safety and care is being undermined

d) 65% stated they were considering leaving the profession

e) 67% stated the cuts were having an adverse effect on their health and safety at work

f) 69% stated the cuts were having an adverse effect on their family life

g) 57% said they were prepared to take strike action if patient care is compromised

Conference acknowledges research from California where they have introduced nurse-patient ratios and from Australia where legally mandated nurse-patient ratios were introduced after a successful campaign by the nursing unions. Evidence has shown that mandated staffing levels are directly associated with a significant reduction in patient mortality as well as maintaining manageable workloads for nursing and midwifery staff meaning their health and safety is maintained.

Conference is not naïve enough to suggest that legally mandated nurse – patient ratios are the total solution and areas such as education, training, mentoring, supervision, skill mix and leadership need to be addressed alongside the introduction of ratios.

It is the view of this conference that a higher ratio of registered nurses to patient, which is evidence based by research findings, demonstrates time and again better quality care outcomes.

Conference recognises the mounting concerns regarding patient safety but also that of our nursing and midwifery colleagues and believes it is imperative to build for action in relation to this issue. UNISON are well placed to mount a high profile public campaign to raise awareness of maintaining and improving safe staffing levels to combat the Government’s propaganda of a protected NHS.

Conference calls on the SGE to campaign on this important issue by making sure that all relevant settings and contexts are not neglected and the campaign is adequately resourced. This campaign must learn from other international models for staffing and evaluate the pros and cons of these different approaches and their applicability to the UK context with a view to making recommendations for strategy and action.

Conference therefore calls upon the Health Service Group Executive to campaign for legally enforceable nurse-patient ratios by:

1) Developing a campaign to introduce evidence based safe nurse-patient ratios suggesting minimum staffing levels of one registered nurse to four patients within general ward areas, recognising that there is a need for a higher ratio of registered nurses within specialised areas. Not only to protect our patients but also our nurses;

2) Building a coalition of support across all interested parties including patient groups, community and voluntary organisations;

3) Working with the Nursing Sector to produce a wide range of materials for use by regions and branches to inform members and the public of the need for nurse-patient ratios within the NHS.

4) Identifying regional and branch leads in order to develop, organise and promote the campaign at a local level;

5) Working with Labour Link and all other sympathetic MPs producing briefings on our proposals, clearly explaining our rationale and the benefits to staff, patients and the NHS.