Leading the way on nursing

A year on from the Francis report and a recent survey by Nursing Times has revealed that more than half of nurses believe their ward or unit remains dangerously understaffed.  This suggests that despite the serious warnings following the catastrophic failings at Mid Staffordshire, little has changed at the NHS frontline.  Given the gravitas of the Francis report, this raises serious questions over the extent of action that must be taken to address the concerns over nurse staffing levels in the NHS across the UK. 

In Wales, the Chief Nursing Officer has issued core principles to all Health Boards to determine staffing levels on medical and surgical wards.  Yet since 2011 we have seen reports by the Health Inspectorate highlighting that over half of Welsh hospitals do not have enough staff, which undermines their ability to provide safe and dignified care.  Wales currently has the highest number of patients per nurse in the UK, which means that all too often our nurses are unable to give the time to perform their role to their highest caring ability. 

In December my proposed bill on Minimum Nurse Staffing Levels was selected from the Private Member’s ballot.  This means that we have an opportunity for Wales to become the first country in the UK with a legal duty on safe nurse staffing levels.  This would help Wales and the Welsh NHS to take a positive step forward in ensuring safe and compassionate care by having the right numbers of nurses on our wards.

Momentum is growing, with increasing evidence from across the world on the positive impact that nurse staffing levels have on patient care and the recruitment and retention of staff.  Nurses who have fewer patients to tend are able to spend a greater amount of time with each patient and as a result can provide better care.  If they are more easily able to identify potential problems with a patient’s care, then they are able to play a preventative, rather than a simply reactive, role and consequently reduce the level of treatment needed and the cost of this care to the NHS.  It also means better support for staff which leads to more manageable workloads, increased job satisfaction and reduced levels of stress or burnout.

In 2013 the Francis Review highlighted that the prioritisation of financial performance over adequate staffing levels was a significant factor in the poor care delivered at Stafford.  The Keogh Review (2013) found that an over reliance on unregistered support staff and temporary staff had subsequent implications for workforce efficiency and cost-effectiveness.  A major study in 2007 by Rafferty et al revealed that patients in hospitals with the highest patient-to-nurse ratios had 26% higher mortality rates; nurses were twice as likely to be dissatisfied in their jobs; to show high burnout levels; and to report low or deteriorating quality of care.

Some places already have mandatory staffing levels, such as California, which introduced a law in 1999 requiring acute care hospitals to maintain minimum nurse-to-patient staffing ratios.  This has resulted in increased staffing levels, more reasonable workloads for nurses, leading to fewer patient deaths, higher levels of job satisfaction and no reduction in skill mix.

Spending on safe staffing levels should be seen as an investment not as a cost, helping to reduce expenditure such as the £132m spent in Wales over the last three years on agency staff or overtime, or reducing the £117m cost of compensation claims.  Better care will mean that patients spend less time in hospital and there are fewer return visits.  

On March 5th Assembly Members will have a vote on whether I can introduce my proposed bill on Minimum Nurse Staffing Levels.  It is time for us to stand up and say that cutting staff numbers and providing undignified or unsafe care is simply not acceptable.  It is an opportunity for change in Wales and I hope that my colleagues will support the principle of the bill and vote yes, so that the bill can progress and we can have a full and proper debate on this important issue.

Kirsty Williams AM is Leader of the Welsh Liberal Democrats