NHS staffing plan 'a step forward'

Hillingdon Times: Hospitals will have to set 'safe stafflng' levels on wards Hospitals will have to set 'safe stafflng' levels on wards

Plans for hospitals to publish data on how many staff are on their wards will be a "huge step" forward in preventing another Mid Staffs scandal, the Health Secretary has said.

From April, patients will be able to see the numbers on a safety website and whether they meet recommendations that will be set down in new guidance.

In a raft of new measures, organisations and individual NHS staff will be encouraged to be more open and honest about errors and problems with patient care.

The Government's response to the inquiry into Stafford Hospital stops short of introducing a minimum staff-patient ratio on wards or enshrining this in law.

Organisations including the Royal College of Nursing (RCN) have called for a minimum of one nurse for every eight patients and Australia and parts of the US have a legal staff-to-patient minimum ratio.

Jeremy Hunt said the Government would not introduce a legal minimum because staff requirements were a "different number for different wards".

Getting hospitals to publish monthly data on ward staffing would be a "huge step" forward, he said, adding that some of the problems at Mid Staffs would have come to light with greater transparency.

The inquiry into the scandal at Mid Staffordshire NHS Foundation Trust, where between 400 and 1,200 more patients died than would normally be expected, put forward 290 recommendations on improving care in English hospitals.

Chaired by Robert Francis QC, it identified a culture where patients were not at the heart of the system and said failings went from the top to the bottom of the NHS.

In today's response, the Government accepted 281 out of 290 recommendations, including 57 in principle and 20 in part.

It rejected calls for healthcare assistants to be registered, saying training would be improved.

There will also be no statutory duty of candour on individual NHS staff to tell patients or their families if incidents have led to serious harm or death.

Instead, the Government will impose such a duty on organisations as a whole and will strengthen duty of candour on individuals using organisations such as the General Medical Council (GMC).

Professional codes of conduct and other measures will be used to create a "common responsibility" for staff to be honest with patients when mistakes occur, whether serious or not, and for staff to report "near misses" that could have led to death or serious injury. If doctors or nurses speak up about errors and problems at an early stage, this would be a mitigating factor in any subsequent disciplinary hearing.

Mr Hunt said: "Nobody makes these mistakes intentionally but if you cover them up, lessons don't get learnt."

Today's proposals also mean that any hospital that has failed to be open with a patient about errors or failings could be forced to pay part or all of a compensation claim rather than the tab being picked up by the whole NHS.

The Government has previously announced plans to create a criminal offence of wilful neglect of patients by doctors and nurses.

Welcoming the report, Mr Francis said the "comprehensive collection of measures" announced by the Government, coupled with the commitment of NHS staff, will contribute towards "a new culture of caring" in the NHS.

Mr Hunt said the NHS had looked at the airline industry, where it was normal culture to report issues or near-misses.

He said: "We want doctors or nurses to think it's in their interest to speak out if there's something that worries them.

"But we're going to go even further. At the moment if a hospital loses a litigation claim, the cost of that litigation award is picked up centrally by the NHS Litigation Authority.

"We're going to consult on changing that so if there has not been proper openness and transparency about patient harm - for example, if a patient or family has been told that death or harm was unavoidable when in fact it subsequently turns out it was avoidable - the hospital risks losing that indemnity which would mean that they may have to pay all or some of any litigation claim.

"We want a signal to go out to every trust board and chief executive in the country, to every doctor and nurse - if you are in any doubt at all, report."

Mr Hunt said there was opposition to legal minimum staffing levels from several organisations, including the British Medical Association (BMA).

"The reason is that it's a different number for different wards. We decided the best way of tackling this was to require all hospitals to collect their staffing levels on a ward-by-ward basis.

"That will be a huge step and means people will know whether some of the problems that happened at Mid Staffs - which didn't happen throughout the hospital, which happened on particular wards - it will be possible to identify that through transparency."

Mr Hunt told the Commons that cruelty became the norm at Stafford.

He said: "One of the most chilling accounts of the Francis report came from Mid Staffs employees, who considered the care they saw as being normal.

"Cruelty became normal in our NHS and no-one noticed."

Under the plans, a "fit and proper persons test" will be introduced so managers who have failed in the past will be barred from taking up posts elsewhere in the system.

Every patient will also have the names of a responsible consultant and nurse listed above their bed.

The National Institute for Health and Care Excellence (Nice) said it will publish guidance on safer staffing levels from August next year.

This will include staffing for A&E units, m aternity units, in-patient paediatric and neonatal wards, and m ental health in-patient settings.

Care Minister Norman Lamb said "bad things happen behind closed doors when you don't have the spotlight on what's going on".

He added: "This rigorous focus on opening everything up for public gaze is extraordinarily powerful."

Mr Francis said the Government's response was "carefully considered and thorough".

He added: "I believe this announcement represents a comprehensive collection of measures which, when combined with the enthusiasm and commitment for culture change of NHS staff and the help of patient groups, will contribute greatly to a new culture of caring and making our hospitals safer for patients."

Christina McAnea, head of health at the Unison union, said: "The Government has missed another opportunity to introduce fixed, safe nurse-to-patient ratios.

"There is safety in numbers when it comes to caring for patients and this one step would bring about a revolutionary change on the wards.

"They are recommending a 'toolkit' to set minimum staffing levels but what will happen if these are ignored when wards are under pressure, which is almost a daily occurrence in today's NHS?"

Frank and Janet Robinson, whose son, John Moore-Robinson, died at Stafford Hospital in 2006, said they were still coming to terms with his death years later.

"It's very difficult to live with the fact that John is dead," Mrs Robinson said.

"But then to keep finding other things out as you go along, it's even worse."

The couple said they had successfully applied for a second inquest into their son's death.

Mr Robinson said the fresh inquest was needed because the first one was insufficient, lasting only 90 minutes and calling two witnesses.

"What hurts most is the majority of witnesses at the new inquest were available to the first coroner," he said.

"He failed in his duty to carry out a preliminary investigation that would have highlighted the failings."

Dr Mark Porter, chairman of the BMA, said: "Patient safety should always be paramount, which is why safe staffing levels should always be set in accordance with the best available evidence and with a dynamic consideration of patients' needs at any one time.

"Centrally imposed mandatory staffing levels would be difficult to implement as they fail to recognise that not every patient is the same and, as such, safe levels will vary from time to time across hospitals.

"The Government is right to want to deal with this through a combination of evidence-based guidance, rigorous governance, transparency and openness."

Dr Peter Carter, chief executive of the RCN, said: "The RCN has been calling for some time for greater transparency in identifying the number of staff on each ward. By making this information available on a monthly basis we are going some way to ensuring that each hospital in the country offers patients access to the care they deserve."

He added: "We also welcome the focus on consistent training for healthcare support workers through the care certificate.

"Although we remain convinced that the mandatory regulation of all healthcare support workers is the most effective way of protecting patients, the announcement today is an important first step."

Emma Jones, from law firm Leigh Day, which represented more than 120 victims of abuse and neglect at Stafford Hospital, said: " We are very pleased to see the way in which the Government has adopted the majority of the proposals put forward by Robert Francis QC; however, we believe many proposals have stopped short of covering every incident of abuse or negligence and may not extend throughout all providers of care within the NHS.

"We are also disappointed that a duty of candour has not been be extended to individuals."

Niall Dickson, chief executive of the GMC, said: " Through our guidance, we have already done a great deal to encourage a duty of candour among doctors, but we are not complacent.

"We know there is more to do. We must strengthen the link between our guidance and doctors' practice on the front line, the words on the page and actions on the ward."

The charity Action Against Medical Accidents (AvMA) said it was "dismayed" that the legal duty of candour on organisations is to be restricted only to death or severe harm cases.

It said the "vast majority of incidents which cause significant harm would not be covered by this rule, meaning that organisations would be breaking no statutory rule in covering up such incidents".

Peter Walsh, chief executive of AvMA, said he was grateful Mr Hunt would consider this issue further "but frankly we are dismayed that he needs any more time to think about it.

"The case for a full duty of candour about any significant incident and applying to everyone in the organisation, from board to ward, is overpowering.

"It would be the biggest advance in patient safety and patients' rights in a lifetime.

"The current proposals would be disastrous - in effect legitimising cover ups of the vast majority of incidents which cause serious harm to patients.

"As well as this being grossly unjust to the patients and families concerned, this means that the NHS would continue to fail to learn lessons.

"When I met him yesterday, Mr Hunt told me he was worried about the requirement to inform patients about all significant harm incidents because it might snare up the NHS in bureaucracy.

"However, NHS organisations already have an existing contractual duty to report any incident of significant harm and the vast majority are already doing this but we want that in law."

Speaking in the Commons, shadow health secretary Andy Burnham told Mr Hunt: "The first Francis report found that Mid Staffs made dangerous cuts to frontline staffing over a short period. I welcome the Government's new focus on this issue.

"But isn't it the case that nurse/patient ratios across the NHS have got significantly worse in the last three years, with 5,890 fewer nurses, more older patients in hospital and bed occupancy running at record levels?

"It is encouraging that the NHS has plans to recruit more nurses this year and is introducing more monitoring. You say things are already changing for the better.

"But are you aware that Monitor has warned that trusts are planning major nurse redundancies in the 2014/16 period, far outweighing any increases this year?"

Mr Burnham also insisted more action is required to raise standards.

He told MPs: "As Robert Francis has said, it's unacceptable the security guard at the door of the hospital is more regulated and subject to professional sanctions than the healthcare assistant tending to an elderly patient."

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