Theresa Fyffe: Nurse numbers must match patient needs

There's clear evidence that having the right number of professional, qualified nurses means better health outcomes for patients and that people receive safer, high-quality care if there are enough nurses to treat and care for them.

Staffing levels obviously need to change in response both to the severity of a patients illness and levels of demand

So the question must be: Given this irrefutable evidence, why haven’t governments across the UK put in place legislation to make sure that all organisations delivering health and care services always have enough nursing staff on duty?

This is not about having a crude ratio of one nurse to X number of patients. Staffing levels obviously need to change in response both to the severity of a patient’s illness and levels of demand.

In Scotland, NHS health boards are already using workforce planning tools, which have been developed and tested over a number of years and support evidence-based decision-making on the number of nursing staff needed to deliver safe, quality care.

Yet despite Scotland’s health boards being directed by the Scottish Government to use these planning tools, which cover 98 per cent of clinical areas in NHS Scotland, this has not resulted in the right nursing workforce being in place to meet patient need.

The latest NHS Scotland staff survey, for example, shows that almost three-quarters of nursing and midwifery staff say there are not enough staff to do their job properly. And in the past, health boards have cut substantial numbers of nursing posts based solely on financial constraints and affordability, rather than patient need and evidence from the workforce planning tools.

At last year’s RCN annual Congress in Glasgow, First Minister Nicola Sturgeon announced that the Scottish Government would introduce safe staffing legislation in this current session of parliament.

This is obviously a step in the right direction and RCN Scotland will be responding to the recently-launched consultation about what the legislation should look like. One of the key points RCN Scotland will be making in its response is that the safe staffing legislation must be enforceable: it must not go the same way as Scotland’s legal 12 week Treatment Time Guarantee for patients, which more than half of all NHS boards missed in 2015-16, with little or no consequences for doing so. The safe staffing legislation can, and must, do better than this.

The legislation must also reflect the importance of nursing in delivering safe, high-quality patient care; it must be transparent; and it must be future-proof. With the integration of health and social care, having legislation which is only applicable to the NHS makes no sense. Health and care settings outside the NHS, such as care homes, must over time be brought within the scope of the legislation.

Critics may argue that legislation is not necessary. However, given the pressures which nurses and health care support workers are currently experiencing, the RCN believes that legislation is the only way to ensure that people across the UK using services are safe and well cared for, and that there are enough nursing staff to deliver that care.

Theresa Fyffe is director, 
RCN Scotland