Safe and sound: What staffing levels would ensure patients receive safe and effective care?

Sally Gosling, CSP assistant director of practice and development, answers some key questions on this topical issue



‘Why is there such a focus on safe and effective staffing levels now?’

Members will be aware of the increasing focus on defining and enacting safe and effective staffing levels in health and social care.

The attention being given to this issue is evident at both a policy and service level, through commissioning and workforce planning decisions, and in the popular media.

The 2013 Francis report (on failings at the mid-Staffordshire NHS Trust) brought to the fore the role of staffing levels (especially in nursing) in upholding patient safety, achieving consistently good care, and ensuring time for care that is delivered with compassion and with respect for individuals’ dignity.

A fresh emphasis on the fundamentals of care and quality comes at a time when services face significant financial pressures.

Staff: patient ratios have re-surfaced as a key component in achieving good quality, compassionate care while ensuring services are affordable. 

A new focus on patient: staff ratios is apparent in recent reports on patient safety.

The National Institute for Health and Care Excellence (NICE) has been asked to to review the available evidence and to produce ‘definitive guidance on safe and efficient staffing levels in a range of NHS settings’ by August 2014.

Staffing levels also have UK-wide relevance and resonance, with related policy developments in each of the countries.

‘What about other aspects of service delivery and workforce design?’

Staffing levels cannot be looked at in isolation from other factors that affect the quality of care that patients receive, the efficiency and effectiveness of service delivery and how services are commissioned and planned.

See below for a summary of these:

  • service delivery models
  • skill mix and role development
  • learning and development opportunities
  • clinical leadership and peer review
  • teamworking
  • data collection
  • standards implementation
  • integration of services
  • service evaluation and re-design
  • supported staff engagement in service improvement and re-design
  • quality employment

A narrow focus on staffing levels risks a superficial approach.

Concerns include:

  • targets being overly focused on cost, caseload management and patient throughput
  • a narrow focus on services and parts of the workforce for which it is relatively easy to specify staffing levels
  • attention to ‘frontline’ staffing needs and a neglect of the staff capacity required to sustain services and make quality improvements
  • assumptions that a single formula can be applied to services in uniform ways
  • a focus on fulfilling short-term needs and a neglect of how services can meet needs in more clinically- and cost-effective ways (including to minimise hospital (re)admissions and reduce the length of hospital stays)
  • a specification of minimum staffing levels that encourage cuts to staff resources, and compromise patient safety and quality of care.

‘What does this mean for physiotherapy?’

With a strong focus on staffing levels, it is more important than ever to make the case for the value and impact of physiotherapy’s contribution to fulfilling patient needs, expectations and outcomes.

There is a real risk that attention on staffing levels becomes focused narrowly on maintaining and enhancing patient: nurse ratios and in acute care settings.

The case needs to be made for physiotherapy’s role in meeting patient goals and achieving long-term benefits and cost-savings, as well as upholding patient safety and the quality of care.  

‘How is the CSP responding?’

The CSP recognises the urgent need to advocate for physiotherapy staffing levels and to support members in activity at a local level.

Last December, CSP Council approved a statement on this topic and the development of interim support for members.

More detailed project work will be commissioned to strengthen how safe and effective physiotherapy staffing levels are articulated.

A fringe session at next month’s CSP Annual Representative Conference  will also have a strong emphasis on staffing levels and strengthening member support in this area.

New work will build on existing CSP resources and reports.

It will be commissioned over the coming months. Staged reporting points and outputs will help to ensure that you receive the support you need as quickly as possible on this key issue, while taking account of any new policy initiatives and guidance (including that from NICE).

The new materials will be practical and simple to use, and will take a rounded approach to staffing level issues.

Key imperatives are:  

  • they need to focus on optimising patients’ experiences and outcomes of cares different specialties, settings, services and team configurations
  • they need to reflect service variables, including the complexity of caseload, managing potential risks to patient and staff safety, and the position of services within broader provision and patient pathways that impact on patterns of patients’ admission to care, experience of care and care transfer
  • they need to reflect all staff roles within teams, including the scope for role development and skill mix review
  • they need to sustain service quality, supporting team members’ continuing professional development, research-related activities, clinical leadership and peer review
  • they need to reflect the impact of service re-modelling on staffing needs, including moves to seven-day services and the increasing integration of health and social care. 

Useful links

CSP statements and resources

  • Visit the CSP website and search for ‘Francis staffing’ and ‘physiotherapy crucial’.

Policy documents/announcements

  •  - Search for ‘Berwick
  • NICE  - search for ‘safe staffing’.

Sally Gosling

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