Proposed changes to staffing in the NHS

Topics covered: Ridouts professional advice

Recent communications between the Health Select Committee and NHS leaders have led to discussions on dealing with the shortage of staff within the NHS.  Suggestions include closer monitoring of staffing at all levels and the use of private firms for routine operations.

Safe staff levels

The Committee has suggested that CQC’s assessment of staffing levels in NHS hospitals should be extended beyond nurse numbers in England to include both midwives and doctors, in particularly in A&E units.  Breaches of the safe staffing levels should automatically trigger inspections by CQC.

The system, which comes into place in April 2014, currently only requires nurse staffing levels to be routinely monitored and published.  The Committee chairman, Stephen Dorrell said “This should be applied across the delivery of health and care – doctors, midwives, practice nurses and social workers.  Part of the difficulty in A&E is driven by the fact there are not enough doctors of all levels.”

A further member of the Committee, Labour MP Barbara Keeley, added “Staffing levels are absolutely fundamental.  It is ludicrous not to be transparent about something that patients and their families can see every day.”

Private firms

Professor Sir Bruce Keogh, NHS medical director, has told the Committee that private firms may be asked to carry out routine operations for the NHS in order to relieve pressure on hospitals, especially during winter period where classically a lot of strain is placed on the NHS.

Keogh stated “We’ve started to look at how the private sector might be engaged in the event of a surge through hospitals, coming through A&E.  one of the issues under consideration is when the going gets rough in winter, often one of the impacts is on elective care, so waiting lists start to drift out, so could more elective care be shifted into the private sector?”

Keogh said that Dame Barbara Hakin, NHS medical director, had met with both the private sector and voluntary sector to see what they could do to help.

One of the main driving factors for the use of private firms arises following serious concerns that hospitals may be unable to handle a sudden spike in demand caused by a bout of cold weather.  In a briefing sent to MP’s on the committee, the NHS Confederation has warned “it is clear from our members that urgent and emergency care is on a knife-edge.  There are considerable concerns about a lack of capacity in the system to respond to a sudden increase in demand for care.  For example, while this winter has so far been relatively mild, our members continue to express serious concerns about the consequences of any sustained drop in temperature….while the situation feels under control at the moment, there is anxiety about the consequences of a sudden change in the weather, given how mild winter has been so far.  A cold spell could lead to greatly increased pressure on our members with there is little slack in the system.”

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