Peter Carter: We need more nurses at the bedside and in the community

While the report focused on a Trust in England, the principles that it sets out applies to Scotland, Wales and Northern Ireland too. Now before I go any further, I got a huge number of emails and letters from members who thought that the RCN, and nursing, came in for too much criticism following the Francis report. I agree.

We have never denied the fact that things should have been done differently on the ground, but Robert Francis could not have been clearer. He laid the blame for the events at Mid Staffs, not with the RCN, but squarely at the feet of the Trust board and managers.

Robert Francis delivered a total of 290 recommendations – and outlined what he thought the future for the NHS needed to look like. Francis made the connection between safe staffing levels and the appalling care delivered in parts of Mid Staffordshire Hospital. He recommended that NICE should develop procedures and metrics that determine what safe staffing levels look like in certain care settings.

These metrics would be evidence-based and would be used by organisations like the Care Quality Commission to determine whether services are up to scratch.

He also said that these metrics should be used by commissioners. All of this sounds very good, and it is. If we implement what Francis recommends, then we’ll see an important improvement, but I’m going to be honest – it doesn’t go far enough.

The need in our NHS for mandatory safe staffing levels has never been greater. Yes, we need metrics and yes, we need guidance. But what we need above all else is feet on the ground, nurses at the bedside and in the community. We need nurse numbers that are enforced by law and based on clinical need.

This doesn’t mean that mandatory staffing levels are inflexible, quite the opposite. We’re not calling for a “one size fits all approach”. Instead, we’re demanding that staff use their local judgment – alongside mandatory staffing levels – which are based on clinical need.

The Government can’t keep kidding itself, it can’t keep labouring under the illusions that numbers don’t matter – the facts prove they do.

The Government’s own regulator in England, the CQC, is now one of the organisations exposing that poor staffing levels lead to poor care.

They recently revealed that 16 per cent of hospitals in England alone have inadequate staffing levels. The CQC stated that in these cases there just aren’t enough staff to “keep people safe”.

How much more evidence does the Government need? How much longer do we have to wait with wards without enough staff? How many more patients need to suffer unnecessarily? This isn’t an exaggeration – it’s an accurate picture of the impact of unsafe staffing and it has to stop and stop now.

We’ve been left thoroughly disappointed by the Government’s response to all of this.

They are still labouring under the naive illusion that numbers don’t matter, and have refused 
to consider mandatory staffing levels.

Until they wake up and face reality, and until they realise the need for enforceable safe staffing, accounts of poor care are going to continue.

There is light at the end of the tunnel. In Scotland, the RCN actually stopped a proposed cut in the student nursing intake, forcing the Scottish Government to reverse its decision. Yes, getting the fundamentals right is essential, but so too is understanding that nursing is about head, heart and hands.

We need to recognise the 
skills of a specialist diabetes 
nurse, who keeps her patients 
out of hospital and makes their lives more comfortable.

We need to understand the impact of the expert dementia nurse, who acts as a bridge between the patient and their families in an ever confusing health and social care system.

We need to appreciate the incredible skill of the neo-natal nurse who cares for a baby no bigger than their hand.

We can’t lose this expertise in the ruthless drive to make savings and cut costs.