Minimum Safe Staffing Levels At Hospitals Needed Says Robert Francis QC

9 October 2013

Minimum Safe Staffing Levels At Hospitals Needed Says Robert Francis QC

Speaking to the Guardian newspaper, Robert Francis QC-whose Francis Report laid bare the extent of poor care and medical mistreatment embedded within Stafford Hospital from 2005-09-has called for wards and units of hospitals which have a low number of nurses and doctors looking after patients safely to be shut down.

Robert Francis QC opined that that it was imperative that hospital administrations ensured enough experienced staff could be in place for relevant wards and units, and that if they were not patients should be sent elsewhere in the meantime.

"If you haven't got the right number of people to fly an aircraft properly, you don't fly the aircraft. You should not be operating if you haven't got enough surgeons on duty who are fit to operate [and] you should not be running a ward if you haven't got enough staff on duty to feed people", said Francis.

"What we need is much more honesty than we have at the moment, I suspect, about when we can't provide the service. And if we can't provide the service safely then actually that place would not provide it."

The Francis Report, released earlier this year, was a major inquiry into poor medical care provided at Stafford Hospital over a four year period from 2005 to 2009 and has been part of a major look into overhauling hitherto poor standards of quality of care and patient safety entrenched within the NHS itself as well as providing a heightened level of scrutiny at the 'culture' inherent within the NHS and the administrations themselves.

Francis also discussed the 'duty of candour' which was necessary to hold NHS staff to account where individual mistakes and unacceptable derelictions of duty had taken place rather than just squaring accountability on hospitals and other NHS organisations collectively.

The health secretary, Jeremy Hunt, who is finalising the government's response to Francis's 290 recommendations is in agreement with this proposal though medical defence organisations have been lobbying against it.

The QC stated in the interview that he believed the NHS should introduce minimum safe staffing levels, a consensus maintained by the Royal College of Nursing, the Patients Association and Labour though not held so steadfastly by the current government.

Dr Mike Durkin, NHS England's director of patient safety, said that while Francis was correct to link staffing levels and patient safety, NHS care providers should publish details of their staffing levels in their board papers instead, mirroring what some hospitals already do for individual wards.

He also rejected a duty of candour for all NHS personnel, claiming that it would prove very bureaucratic and distract staff from caring for patients.

Dr Johnny Marshall, director of policy at the NHS Confederation, which represents hospitals, said: "Staffing levels should be transparent for all patients to see" but rejected staff quotas as unnecessary. Levels of safe staffing should be decided locally, not nationally, he added.

A universal duty of candour "could have unintended consequences, creating a culture of blame and fear that could undermine efforts to improve patient safety. The appropriate place to apply such a duty is with healthcare organisations, whom we rightly expect to be transparent about their failings and the actions they are taking to correct them," he said.

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