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Patient safety: why measuring NHS staffing levels is not enough

By Justin Creigh, PA healthcare expert

Since 2014, NHS hospitals have had to report on staffing levels on their wards on a monthly basis, as well as follow National Institute for Health and Care Excellence (NICE) guidance on safe staffing levels.

The NHS England’s chief nurse, Jane Cummings, as well as the National Quality Board, have taken the lead to ensure NHS Trusts can determine appropriate nursing levels and, with 3,700 new nurses qualifying for employment in 2013/141, it is likely that there will be sizeable increases in nursing numbers.

In reporting staffing levels alone, however, we risk creating a false sense of security on what constitutes service quality and, ultimately, patient safety.

Although the focus on staffing levels will help create safe hospital wards, with staffing levels reported and assessed within a safe range, the picture will be misleading. To avoid this, other performance drivers must be taken into consideration.

Safe staffing levels must be one of a range of measures

In addition to safe staffing levels, NHS managers must take account of a range of other performance drivers including:

  • planned staffing numbers that contextualise changes; for example, lower than acceptable staffing levels could be explained by the movement of acute activity into primary settings

  • the mix of experienced and newly qualified staff and their length of service, highlighting the risk that those hospitals most desperate to address staffing shortfalls may do so with inexperienced staff

  • metrics demonstrating evidence of continued personal and professional development, including compliance with compulsory training requirements

  • staff turnover levels and the mix of permanent to temporary staff on wards, which have  implications for working relationships between healthcare professions and wider ward knowledge

  • sickness and absence levels, which have a potential impact on service capacity and patient care if not appropriately mitigated

  • service indicators, such as healthcare acquired infection (HCAI) rates, serious untoward incident (SUI) rates, inpatient survey results and the number of complaints being received.

Reviewing the full range of indicators, including safe staffing levels, will enable NHS managers to gain a more rounded view of performance and better connect and identify the levers they have to really influence outcomes.  In contrast, by focusing only on staffing levels, we would risk missing what really counts in providing safe and high-quality service to patients and ensuring patient safety.

To find out how PA is helping health organisations address workforce performance challenges, please contact us now. 

1.Source: Health Education England:

Catharine Berwick
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Chris Steel
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