Staffing levels: give us a tool for optimum staffing levels

A new tool from the CSP – designed to help members decide appropriate staffing levels – is due to be launched soon. Shan Aguilar Stone outlines what it’s about.

What does an appropriate, and safe, staffing level look like? That question has been uppermost in managers’ – and professional bodies’ – minds since the Mid-Staffordshire inquiry. The Francis inquiry findings, published in 2013, highlighted the problem of having ‘inadequately trained staff who were too few in number’.
While the focus was initally on safe nursing levels, the review threw the spotlight on staffing levels across the board. And the CSP was keen to ensure it offered members – and managers – guidance on what levels of physiotherapy staffing were appropriate, not just nursing ones. 

What is the staffing evaluation system for leaders  decision support toolkit?

The CSP’s new Staffing Evaluation System for Leaders (SESL) toolkit is designed to support and inform how members appraise their staffing levels to deliver a safe and effective service.  It has been shortened to ‘SESL’ –pronounced ‘Cecil’ for ease – and places staffing levels firmly in the context of patient need and outcomes and the service delivery model, rather than looking at staffing levels in isolation. 
It is not just a simplistic number-crunching device. The tool takes account of – and respects – members’ professional insight and understanding in making judgements about the staffing resource required for their service delivery to patients. 
At the same time, the tool helps members to evaluate and think critically about the complex factors relating to staff resources and deployment. It also supports members in making a robust case for the staffing resources required to deliver a safe, effective service.  

Why is the CSP releasing this tool now?

For some time, there has been a strong focus on staffing levels as part of assuring the quality of patient care. This sits within the context of the findings of the Francis inquiry, increasing financial constraint, rising expectations and demand on services. It is also about achieving the correct approaches to deploying the workforce so that staffing is responsive to changing patient needs. This is achieved through different approaches to skill mix, role development, and multidisciplinary team working, as well as staff numbers. 
Across the UK, there are different approaches to deciding what are appropriate staffing levels. The Scottish government is expected to progress legislation on safe staffing levels this year, while Wales progressed legislation on nurse staffing levels in 2016.
Of central importance is being able to assure patients, their relatives and carers that care is of a consistently good quality. It should not compromise individuals’ safety or dignity, and should be delivered with compassion, regardless of sector or setting, and in spite of financial constraint at a time of increasing demand. Recent winter pressures on services, with an unprecedented demand for A&E services, along with increased demand to discharge patients early from hospital into the community, have highlighted the significance of these issues. 
While staffing levels are a significant element in providing this assurance to patients and their families, they cannot be addressed in isolation from other factors that impact on the quality and outcomes of patient care. In addition, they cannot be calculated using prescriptive approaches to staffing resources 
that assume workforce needs are the same across settings and service delivery models. 

What the tool can – and can’t – do

For all these reasons, the SESL tool allows the user to consider a range of factors that contribute to ensuring safe, effective, patient-centred, timely and compassionate care.

These factors include: 

  • service delivery model
  • patient acuity and dependency, caseload management and risk stratification
  • skill-mix review and role development
  • clinical leadership and peer review 
  • team-working
  • standards implementation
  • integration of services
  • achieving sustainable service delivery
  • service evaluation and redesign
  • learning and development opportunities
  • supporting staff engagement in service improvement/re-design
The tool can be used to review existing staffing levels, or proactively to consider issues relating to changing staffing needs (for example, arising from responding to changing patient needs, or shifting service delivery model – including to a seven-day service). For either purpose, it can help to make a robust case for staffing resources. 

The tool does not do the following 

  • make the decision for the user about the staffing levels required to deliver a specific service
  • formulate a specific number relating to the staffing resource required to deliver a service
  • generate a gap analysis between the existing physiotherapy staffing level and a safe and effective level
  • prescribe a specific skill mix for a service or team 

Why doesn’t the tool generate a number?

The tool won’t calculate how many staff are needed because the safety and effectiveness of services and patient care is influenced by far more than staffing numbers alone. 
There are disadvantages to defining, for example, the minimum or maximum number of staff required to run a service. Providing a minimum number could suggest that this number is sufficient to run a safe and effective physiotherapy service. It is also presumes that changes to patient need, service delivery model and skill mix have no impact on the staffing required. 
A focus on a staffing number also detracts from the importance of a focus on the quality of patient outcomes, including the impact of a service further along a patient pathway (for example, in reducing hospital admissions, re-admission, or length of stay).
Evidence is not available to suggest specific physiotherapy staffing numbers for service delivery. There is also an increasing recognition in healthcare that staff-patient ratios might not be helpful, or that they are grounded in available evidence (see footnote*).
The SESL tool helps members to identify and articulate the physiotherapy staffing resources required to deliver a particular service to uphold and enhance the quality of patient care, while demonstrating cost effectiveness. It can also help in considering staffing resources where multidisciplinary team working is central to the service delivery model and patient needs.

Who is the decision support tool for?   

The tool is designed to be used primarily by physiotherapy mangers and team leads. However, it is available for all CSP members in all sectors and settings, including workplace stewards.

Why use the decision support tool?

The SESL tool aims to facilitate members’ understanding and engagement in an issue of high priority, complexity and urgency within service delivery and policy. It is designed to help members to define and advocate the staffing resources required to meet patient needs. It also supports members’ professional learning and development.
The tool supports members to look at the future sustainability of their services as part of their decision-making process. On this basis, they can make an informed case for the staffing and professional activity needed to underpin the development and delivery of high-quality patient care. This includes access to continuing professional development, peer review and clinical leadership, and contributing to the education of future members of the profession. Such areas can be side-lined in some approaches to staffing levels, under-estimating staff resource.  
  • Shan Aguilar Stone is a CSP professional adviser 
*‘There is no evidence base to support a specific ratio; instead staffing requirements should be decided using patient acuity and dependency data alongside throughput, and the skills and experience of the wider multi-professional team.’ [National Quality Board 2017 Safe, Sustainable and Productive Staffing: An improvement resource for urgent and emergency care] 

The SESL decision support tool at a glance

The tool consists of two self-assessment questionnaires:  

  • Stage 1 focuses on understanding service-specific factors relating to patient need, service delivery model and workforce capacity that are relevant to delivering safe and effective care
  • Stage 2 focuses on confidence in actual service-specific staffing levels. 
Each stage focuses on three areas: patient need; service delivery; and workforce capacity. Each area focuses on three statements against which users are invited to rate their understanding or confidence.
Stage 1 helps the user to understand a wide range of factors relevant to delivering safe and effective care. This includes patient needs, service delivery and workforce capacity. The questions offer suggestions about issues to be considered and are designed to support critical thinking offer an approach to recording and capturing key data and issues encourage the user to consider a range of factors that may impact on staffing needs. 
The tool signposts members to various e-Bite learning activities within the CSP Learning Hub. These e-learning resources have been developed to aid members in capturing their thoughts, and allow for reflection on issues relating to their access, use and confidence in data on patient needs, service delivery and workforce capacity. 
It is possible to partially complete a stage and return to it later, as can the e-Bite learning materials. 
The tool output is a repeatable dashboard of findings, using a red, amber and green scoring system, with feedback and suggested actions. For example, it will review and interpret the interaction of factors that contribute towards SESL.
Because it sits in the CSP Learning Hub, the tool offers secure storage to users, enabling repeat/review use. It also enables the CSP to collect anonymised user trend data.

Where can I access the tool?

The SESL decision support tool is accessible via the CSP Learning Hub. Members need to log onto the CSP website and access the Learning Hub via the e portfolio. 
For information on how to log on to the Learning Hub, see
A five-minute video explains how to access the tool, along with how to navigate use of the tool

How long will it take to complete? 

This will vary, depending on the amount of detailed thinking time the user wishes to allocate to the tasks. Remember, it is possible to partially complete the stages and return to them later.

Will the CSP have access to SESL data? 

The CSP will analyse general trends in members’ use of the tool through aggregated and anonymised data. This will be helpful to pick up on trends. Individual users’ information will not be shared.
We will also regularly seek feedback from members on the value of the tool and how its functionality can be improved. 


  • Author Shan Aguilar Stone CSP professional adviser

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