Nurse ratios to be published by trusts for first time

(NursingTimes.com) Nurse-to-bed ratios are to be published for every hospital in England under plans to monitor quality in the reformed NHS, Nursing Times has learnt.

A “quality dashboard” is currently being developed by the Department of Health, which is intended to act as a transparent measure of trust performance.

The dashboard will feature a range of information about trusts, including the number of registered nurses they have per bed. It will also include a doctor-to-bed ratio, staff and patient survey results and more traditional measures such as data on healthcare associated infections and mortality ratios.

Nursing Times understands trusts will be expected to update the information on their nurse-to-bed ratios at least every three months.

The inclusion of the workforce measure in the dashboard follows high profile debate about whether the government should set minimum staffing levels for hospital wards.

It is also one of the issues Mid Staffordshire Foundation Trust public inquiry chair Robert Francis said he would consider when producing his report, which is due in the autumn.

Work to develop the dashboard is being led by DH national director for quality Ian Cumming. He told Nursing Times the measure was intended to start a conversation and not be a “pass or fail” for trusts.

“The nurse-to-bed ratio is one of a number of workforce measures. What we’re not doing is passing any judgement about what’s the right level of nurses to patients,” he said.

In a session at last week’s NHS Confederation conference in Manchester, Mr Cumming told delegates that while compiling the quality dashboard, his team had found that the registered nurse to open bed ratio currently ranged from 1.1 to 2.4.

Both the Royal College of Nursing and Unison have been calling for the introduction of mandatory staffing levels.

Unison head of nursing Gail Adams told Nursing Times the dashboard measure represented progress. But she said it was weakened by using nurse-to-bed ratios, rather than nurse-to-patient ratios and for failing to take account of the acuity of patients.

RCN head of policy Howard Catton echoed her concerns. He said: “The nursing workforce is so critical to patient safety that it needs a set of high level metrics to tell you about the nursing workforce. That’s something we have been calling for and we welcome [the dashboard].

“However, there is a risk that [by] measuring the bed, you are not measuring the usage of that bed and you’re not saying anything about the dependency of patients.”

He also pointed out that the nurse-to-bed measure would not reflect caseloads outside the acute sector. The government is increasingly keen to see traditional hospital services provided in the community, despite evidence that district nurse numbers are falling.

The dashboard is due to be published next month to allow organisations to get used to it and make any suggestions for improvement before it is rolled out fully next year.

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