Getting it right: Staffing levels

The thorny issue of what constitutes an appropriate staffing level Is being tackled by the CSP and external experts.



The Francis review of services in Mid-Staffordshire NHS Trust commented on the need for appropriate staffing levels. As a result, the spotlight has fallen on what is the ‘right’ number of clinicians for a certain number of patients. The focus had been particularly on nursing care, but it is important that physiotherapy engages with the issues.

There are no simple answers to safe and effective staffing, and no ‘ideal’, standard staff:patient ratio. Requirements vary depending on patient need, service environment and wider staffing issues.

To help members decide what’s right for their service, the CSP has commissioned an external team of experts to help.

Project consultants will be developing an online tool and guidance for members to consider safe and effective staffing for their patients, within their service context. The work will be completed by April 2015.

In our Q & A, CSP professional adviser Rebekah Middleton, who is leading the project, explains more.

Why is the CSP doing this?

Physiotherapy is patient-focused by nature. Every contact with our patients must be based on quality, compassionate care, delivered in ways that are best suited to meeting patient needs. The project will give members a clear way to identify and describe the physiotherapy resources needed to deliver a safe and effective service. The approach will uphold a genuine focus on the patient and enable individual teams to take into account a breadth of factors that influence the quality of patient experience and outcomes – from the extent and nature of patient need and dependence, the service delivery model, to the staff skill mix.

Will it look at the independent sector as well as the NHS?

Yes. The project will take into account the full diversity of physiotherapy, including settings, sector and service delivery methods, such as seven-day services. The approach will also be inclusive of the four nations. Member involvement will be key to shaping, informing, testing and refining the results. Members will be kept abreast of ways in which they can get involved as the project develops. 

Will it mean we can argue for more staff?

That depends. The central outcome of the project will be an evidence-based approach to ensuring a safe and effective staffing level for your service. The on-line tool will allow you to input details for your service and will help you to appraise the significance of factors, so you can tailor how you make the case for how your patient needs can be met. The tool will enable you to factor in variables about your patients, such as level of levels of dependency, service environment, such as ward layout or unit size, and staff factors, including skill mix and building in time for leadership and management activities, service evaluation and research, CPD and practice education. The combined perspective will give a rounded view of the staffing required.

How will I be able to use the tool?

The tool will support you in investigating the unique nature of your patient group, service environment and team. It will help you to take stock of your current level of resource and think carefully about how best to use it, or if you need to make the case for increased resources.

If you feel the staffing levels are inappropriate, it may be time to speak up.

You will be able to use the tool to do this from an informed position, and by relating staffing needs directly to safety, ensuring high-quality, compassionate care, and optimising patient outcomes, value and impact. 


What are the issues?

There are five main themes within the project:
Physiotherapists have a key role to play in ensuring the safety of patients in all settings and optimising patient outcomes in cost-effective ways. But there isn’t a simple link between staffing levels and patient benefit. Much has been said recently about staff:patient ratios, especially in acute ward settings and for nursing. But there is no magic number to be applied. Adequate staffing levels are only part of the answer.

Physios are experts in team-working and every interaction with patients is about collaboration. Many factors impact on patient care and outcomes. Our approach will embrace these, avoiding simply focusing on staff inputs and tasks.

We must raise our profile and recognition of the value of our contribution to patient care. There is a risk, particularly as a result of media attention on doctors and nurses, that the contribution of physiotherapy and other allied health professions is overlooked. The National Institute for Health and Clinical Excellence safe staffing programme and draft legislation in Wales, for example, centre on nursing only. The project will strengthen our participation in debates on safe and effective care and support members to make the case for resources to meet patient needs in clinically and cost-effective ways.

The staffing of a service needs to balance skills, sufficient number of staff and the outcomes to be achieved. The resources that are developed will put us all in a stronger position to present what is needed for a cost-effective and clinically effective service.

It is essential to have a workforce that is sustained at appropriate levels and which is ‘future-proofed’ against possible changes in care provision, such as providing more services in a person’s home. These factors are an integral part of the solution for patient safety long term. Education, research activity, professional development and leadership activities are also key to quality standards and patient safety.

  • See our CSP news story titled 'Safe and Sound'  to offer staffing advice, page 8 Frontline, 1 October 2014

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