Exclusive: Minimum of one nurse to eight patients, hospitals to be told

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Hospitals across England and Wales are expected to be warned next week that having one nurse looking after more than eight patients could jeopardise safety.

Sources told The Independent that the National Institute for Health and Care Excellence (Nice) would broadly endorse minimum staffing levels on acute wards with care for patients who have had operations or are in need of close medical attention.

The advisory body was asked to examine staffing levels on wards following the Francis Inquiry into the catastrophic care failings at Mid Staffordshire NHS Trust.

It is due to publish its guidance on Monday following an extensive review of academic evidence on the effect of staffing levels on patient mortality and adverse incidents. The Government has resisted calls to prescribe minimum staffing levels for fear that some hospitals might use it as an excuse not to increase cover when it was needed. It is an approach which has been endorsed by an independent report by Professor Don Berwick, a hospital safety expert.

He said that while a nurse-to-patient ratio of the one in eight was an important benchmark, staffing decisions must be taken on the basis of individual circumstances and might need to be higher.

“Recent work suggests that operating a general medical-surgical hospital ward with fewer than one registered nurse per eight patients, plus the nurse in charge, may increase safety risks substantially,” he said. “[But] this ratio is by no means to be interpreted as an ideal or sufficient standard; indeed, higher acuity doubtless requires more generous staffing. Our primary recommendation on staffing patterns is that Nice undertakes as soon as possible to develop and promulgate guidance based on science and data.”

Sources outside Nice told The Independent that the organisation would come close to saying that the one-to-eight ratio should be generally regarded as the minimum safe staffing level. 

Wards with higher ratios should automatically raise safety concerns, according to Pippa Hart, the director of nursing at Epsom and St Helier University Hospitals Trust, who is a member of the Safe Staffing Alliance “If you have more than eight patients to care for then the risk of harm significantly increases,” she told delegates at a nursing conference recently.

Elaine Inglesby, nurse director at Salford Royal Foundation Trust, told the conference that the reality of staffing levels in hospitals “can be quite scary sometimes”.