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Hospital red flag events should prompt staffing action, says Nice Hospital red flag events should prompt staffing action, says Nice
(about 9 hours later)
Complaints by patients, their relatives or carers about failures in providing basic care should force NHS hospitals to look at immediately increasing the number of nurses on overnight wards, under new guidance.Complaints by patients, their relatives or carers about failures in providing basic care should force NHS hospitals to look at immediately increasing the number of nurses on overnight wards, under new guidance.
The National Institute of Clinical Excellence (Nice) has drawn up a list of "red flag events", which can also be reported by nurses, including lack of patient checks, omissions in providing medications and delays in issuing pain relief, which will act as a trigger for considering increasing staff numbers. Another warning sign will be if there are fewer than two registered nurses on a ward during a shift. The National Institute for Health and Care Excellence (Nice) has drawn up a list of "red flag events", which can also be reported by nurses, including lack of patient checks, omissions in providing medications and delays in issuing pain relief, which will act as a trigger for considering increasing staff numbers. Another warning sign will be if there are fewer than two registered nurses on a ward during a shift.
Elizabeth Rix, director of nursing at University Hospital of North Staffordshire and a member of Nice's safe staffing advisory committee, said: "If you are informed that more nurses are required then you need to look at what else you have got available in the hospital at the time. If you can't move away the resources to help [from other wards], you need to think about how else you can do it."Elizabeth Rix, director of nursing at University Hospital of North Staffordshire and a member of Nice's safe staffing advisory committee, said: "If you are informed that more nurses are required then you need to look at what else you have got available in the hospital at the time. If you can't move away the resources to help [from other wards], you need to think about how else you can do it."
The committee's chair, Miles Scott, chief executive of St George's NHS trust in south-west London, said red flags indicated something that needs "addressing there and then, not waiting for a review months later" .The committee's chair, Miles Scott, chief executive of St George's NHS trust in south-west London, said red flags indicated something that needs "addressing there and then, not waiting for a review months later" .
Nice intends that hospitals should publish their red flags and be held to account for them by the chief inspector of hospitals.Nice intends that hospitals should publish their red flags and be held to account for them by the chief inspector of hospitals.
The regulator abandoned plans in its draft guidance to set a maximum staff-to-patient ratio of one to eight, arguing that different patients and different wards have different needs. It will not be a red flag but Nice said hospitals should bear in mind "there is evidence of increased risk of harm associated with a registered nurse caring for more than eight patients during the day shifts".The regulator abandoned plans in its draft guidance to set a maximum staff-to-patient ratio of one to eight, arguing that different patients and different wards have different needs. It will not be a red flag but Nice said hospitals should bear in mind "there is evidence of increased risk of harm associated with a registered nurse caring for more than eight patients during the day shifts".
The guidance, issued at the behest of the Department of Health and NHS England after the issue of staffing levels was raised in the Francis report on failings in Mid Staffordshire hospitals, was dismissed by groups campaigning for improved quality of care.The guidance, issued at the behest of the Department of Health and NHS England after the issue of staffing levels was raised in the Francis report on failings in Mid Staffordshire hospitals, was dismissed by groups campaigning for improved quality of care.
Susan Osborne, chair of the Safe Staffing Alliance, said the 1:8 ratio should have been a red flag, and argued that the guidance was anyhow "skirting around the problem. We know that the vast majority of hospitals are understaffed."Susan Osborne, chair of the Safe Staffing Alliance, said the 1:8 ratio should have been a red flag, and argued that the guidance was anyhow "skirting around the problem. We know that the vast majority of hospitals are understaffed."
The Health Service Journal reported on Monday that 105 out of 139 acute trusts had missed their own targets for filling shifts with registered nurses as opposed to healthcare assistants.The Health Service Journal reported on Monday that 105 out of 139 acute trusts had missed their own targets for filling shifts with registered nurses as opposed to healthcare assistants.
Katherine Murphy, chief executive of the Patients Association, said a senior clinical member of staff should determine staffing levels. "It shouldn't be down to patients to worry about red flags," she said.Katherine Murphy, chief executive of the Patients Association, said a senior clinical member of staff should determine staffing levels. "It shouldn't be down to patients to worry about red flags," she said.
The regulator declined to say how many nurses needed to be hired to make sure its recommendations were implemented, but said it expected the cost to be £200m – 5% of the current cost for nursing staff in acute wards.The regulator declined to say how many nurses needed to be hired to make sure its recommendations were implemented, but said it expected the cost to be £200m – 5% of the current cost for nursing staff in acute wards.
It said long-term savings could be substantial, including up to £1bn a year through reducing the number of patients getting bedsores and up to £700m a year preventing infections after surgery.It said long-term savings could be substantial, including up to £1bn a year through reducing the number of patients getting bedsores and up to £700m a year preventing infections after surgery.
The health secretary, Jeremy Hunt, said there were 6,200 more nurses than in 2010 and the guidance would help the NHS to use staff as effectively as possible.The health secretary, Jeremy Hunt, said there were 6,200 more nurses than in 2010 and the guidance would help the NHS to use staff as effectively as possible.
• This article was amended on 15 July 2014. An earlier version referred to the National Institute of Clinical Excellence instead of the National Institute for Health and Care Excellence.