Nurse staffing level debate misses the point, says ex-NHS Employers chief

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Former NHS Employers chief Dean Royles

Former chief executive of NHS Employers explains that targets are just the tip of the iceberg

Nursing staffing levels have been intensely under the spot light, as acute trusts revealed they had failed to hit targets of hours worked by registered nurses. Undoubtedly, evidence suggests that staffing levels are important to maintaining high levels of patient care, with a particular nod to the influence that nurses have on a speedy recovery. However. NHS Employers former chief executive Dean Royles believes that statistical targets may be missing the wider point.

“When there aren’t enough staff, I have heard people say you can ‘smell’ poor care in an organisation and people will also say you can tell when a ward is too stretched and the staff aren’t caring. Safe staffing is self-evidently a good thing but safe staffing and good care involve more than crude nurse ratios,” Royles explains in an NHS blog post.

“Nurses are absolutely essential to safe care and to great care. But if the NHS has learnt anything in the last few years, it is the danger that comes from hitting the target, but missing the point,” he continues.

Other staff matter

Royles raises the issue that it isn’t just nursing levels that need to be under fire, but the collaboration of the ward staff, and the interaction of different teams to produce united good care. “Nurse ratios don’t take account of the role of speech therapists, occupational therapists, physiotherapists, dietitians, etc. Will vacancies be held in these staff groups to pay for more nurses?” Royles wonders.

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He believes that a ward/nurse ratio comes with numerous risks, the first being that a minimum number will soon be viewed as a maximum, and staff from busier wards will be redeployed to meet ratios.  Royles also worries how this could affect other departments, saying “The ratios are about acute ward nurse levels – that’s really important but does this mean that until further reports are published, we give less priority to areas like community nursing, learning disabilities, mental health nursing, health visitors and so on?”

There could even be financial impacts on other staff, with hospitals seeking to employ more nurses, but no additional funding in the bank. There may also be links to skill sets, with Royles pondering whether more junior members of staff will be more commonly seen at the expense of specialist nurses.

Complex debate

“Healthcare is changing fast. Thirty years ago, the average length of stay in hospital was 12 days and that required a particular set of skills. Now, the average length of stay is less than five days. Physios and other therapists help recovery. If we concentrate solely on nursing then getting the right skills mix at the right time will become harder,” Royles adds.

Royles concludes by commenting that the issue is far more complex than a sheet of targets would have us believe, with contributions across a wide scope of teams needing to be taken into consideration as well as the important aspect of nurse staffing levels, since all of these factors interlink for good patient care. “Great care involves other professionals too. Let’s not put that at risk simply because it is easier to come up with a model for one group of staff,” Royles urges.


[testimonial name=”Recruitment Influencer – Dean Royles” who=”Director of HR and Organisational Development at Leeds Teaching Hospitals NHS Trust” imagelinks=”” vertical=”no”]”Previously the Chief Executive of NHS Employers, Dean and his team focused on developing a workforce that centred around patients.”[/testimonial]