25th June 2015

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The right call 
News and Comment from Roy Lilley

When the history of the modern NHS is written I hope it will give a mention to the University Hospitals Coventry and Warwickshire Trust. They are worth more than a mention because they have something really valuable.


I'm not talking about their staff, although I am sure they are priceless, neither am I talking about their peerless leadership, as marvellous and lovely as it is. I'm talking about data. They have data that I will be surprised if many other hospitals can match. They have performance data.


We all know it will be data that will replace the lead-foot CQC, data that will shape the future of the NHS and it will be data that will keep us fitter for longer.


Knowing what we did yesterday, figuring out if it was any good and putting things in place to make sure we get it tomorrow and the next day, 'till we don't want it anymore, is the secret of consistency which is the magic ingredient we call 'quality'. The building blocks... data.


UHCW has some special data, going back ages, linking staffing levels and patient outcomes. Prof Alison Leary has been digging into it and produce a report; a leaked copy of which the HSJ has managed to get hold of. Well done them.


As painstaking as the report is, as clever as the analysis is, it doesn't tell us anything that intuition and a bit of common sense won't tell us. More nurses means safer care. Better qualified staff means better caring. You knew that didn't you? Well, for the first time we have the evidence; rock-solid, home-grown evidence.


I know you will tell me there has always been evidence and you are right. There is evidence from Australia and the US but it is not from here which allows the naysayers to turn up their noses.


Alison has produced evidence as British as the White Cliffs of Dover and as home-grown as a runner bean from yer Granddad's allotment.


Prof Alison's work is very important but it is more significant that might be thought, at first sight.


Until now the NHS has had to rely on the entirely useless 'safe staffing' guidance provided by NICE; with their red-flags and 'let yer granny sit in wet sheets before someone tries to find another nurse', one-to-eight rubbish.


They, in part, relied on the work of Anne Rafferty et-al and, in my view, put it in entirely the wrong context  Nice also said;


(Sec 3) there is a lack of high-quality studies exploring and quantifying the relationship between registered nurse and healthcare assistant staffing levels and skill mix and any outcomes related to patient safety, nursing care, quality and satisfaction;


Well, they didn't look hard enough, did they? They didn't get off their backsides and go to Warwick. They didn't do what the excellent Prof Alison Leary did. They could have done. The evidence was there waiting for them. Right under their noses.  Why didn't they do it?  Good question.


I have written consistently that the NICE 'safe staffing' guidelines are at best unhelpful and at worst dangerous. Waiting for a red-flag incident is not my idea of 'safe staffing'. Why did they put their name to this junk mail?


I'll suggest an explanation.


No one will ever convince me that NICE were not leaned on by the DH, who, incidentally, were consultees in the process. Staff ratios, that are safe, mean more nurses, we know that. Workforce planning has been a disaster, training place funding was cut and there is a crisis in nurse recruitment. Better ratios means more nurses, means more funding and that means very difficult questions for the DH.


I understand the concerns surrounding the NHSE's decision to take the safe staffing agenda away from NICE; a sinister move, to cut costs?


Ask yourself this question; who commissioned Professor of Workforce Modelling Alison Leary to go to Warwick and produce this report? The answer is NHSE, the Chief Nurse, Jane Cummings.


I say NICE have made a mess of safe staffing and I wouldn't trust them to do anything further. I wrote, last week, nurse ratios are a matter for nurses. This week I still feel the same.

When the history of the modern NHS is written, I think it will show the Carbuncle made the right call.


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