Yesterday this research based report argued “There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’ “. To investigate this a survey was undertakenof 2917 registered nurses in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. This is a decent enough sample frame to begin to make inferences, so what did the researchers conclude? That, according to this cohort care is frequently left undone and that this, unsurprisingly, is related to lack of time. The activities include: comforting or talking with patients, educating patients and developing/updating nursing care plans. Two factors also highlighted was that 1) the number of patients per nurse and 2) ward patient safety ratings are significantly associated with missed care. This report follows a warning by nurse leaders over nursing numbers and a call for minimum staffing levels.
The wider context is of course the concern around the quality of nursing and medical care given in some Trusts, some of which have focused on ‘compassion in care’. However, following the publication of the Francis Report, the health secretary, Jeremey Hunt, failed to argue for minumum staffing levels. That being said NICE is working on a tool to be used to establish just such levels. It has been reported that Hunt confirmed that it is not the job of the health secretary to do so.
It is very hard to see that when the NHS is experiencing the Nicholson challenge and may well have to deliver further costs savings that Trusts, will spend any more on staff. Considering ward budgets, pay for staff can be the single biggest expenditure. The context is that, as I heard clearly stated in a Trust recently, that “this is not a hospital, this is a business” and that budgetry control involves making financial savings year on year. Bruce Keogh, in his recent 2013, report argued that three dimensions of quality were: clinical effectiveness, patient safetey and the patient experience. These three in reality have to be delivered withing a context of cost savings.
This is market discipline in the health service. Private sector organisations (whether they for example, like Farmers, receive state subsidies or not) know this discipline very well. Control your costs or you competitiors will undercut you and force you out of business. However, even in the private sector cost is not the only concern – quality is and customers make decisions not only on cost but the quality of the service or product.
People know however that the NHS is not a private sector organisation and that switching brands is not an easy way to signal dissatisfaction. People also know that poor staffing levels seriously diminishes the quality of the service they recieve. there is no geting away from the fact that care costs money.
This is therefore political and a social battle. The NHS is currently compared to other healthcare systems very good value for money. However, chroinc staff shortages will challenge public support and may make some consider private provision. This is the wrong solution to the wrong problem.