Professor Ted Baker, Chief Inspector of Hospitals, introduces CQC’s latest resource showcasing examples of effective staffing in health and care.
We are all well aware of the pressures facing health and care providers, exacerbated by increased demands and workforce shortages. The recently published interim NHS People Plan sets out a welcome vision for how people working in the NHS will be supported to deliver care and what actions are needed to help them. While the ambitions in the plan are consulted on and realised, there is much we can do to use the staff we have available to their greatest effect.
Safe, effective staffing is about having enough staff with the right skills, in the right place, at the right time.
In our inspections, we always assess staffing as part of rating a service on safety. These assessments include observing how care is delivered, listening to staff and patients, and assessing the outcomes of care. We also discuss staffing needs and challenges with clinical managers, including how they monitor and meet planned staffing levels. However, we do not use staffing ratios as the sole determinant of a rating.
We want to support providers to look at staffing in a flexible way, which is focused on the quality of care, patient safety, and efficiency, rather than just numbers and ratios of staff. This may mean that providers need to think differently or consider redesigning a service to make the best use of the range of skills they have available.
They should also think about how they work with the whole health and care system to enable different disciplines to support each other to make sure that patients have the best possible journey on their care pathway. This supports the ambitions set out in the NHS Long Term Plan to make sure the NHS is fit for the future and is focused on integration and collaboration.
Our new resource showcases case studies of providers who have embraced this approach, and I would encourage others to learn from their experience.
We see how physiotherapists working as a first contact practitioner in GP services in Nottingham and Hampshire can improve the patient pathway and have a positive impact on GP capacity; and how occupational therapists in a central London emergency department have helped prevent unnecessary hospital admission and supported timely discharge.
In East Lancashire, the trust has worked with commissioners to transform community services and provide integrated care, coordinated around the needs of individuals. It also consulted on how to create a new acute care team to make sure that it had a clear vision and the right mix of skills to be able to respond to quickly when a patient’s condition worsens.
The value of allied health professionals (AHPs) comes to the fore, and we see how physiotherapists are being used on stroke rehabilitation wards in Leeds, and how Oxleas NHS Foundation Trust responded to feedback from patients and staff by employing psychology graduate healthcare assistants to work on mental health wards. Suzanne Rastrick, Chief Allied Health Professions Officer (England)at NHS England and NHS Improvement, and Health Education England Chair, Sir David Behan talk more about the important role of AHPs in their blogs.
This is just a snapshot of the case studies we have produced, but what they all show is that effective staffing is about working flexibly and taking a whole system, integrated approach. Ultimately, though, effective staffing is about multidisciplinary teamwork — not silo working.
Take a look at the case studies on our website, and read supporting blogs from Sir David Behan of Health Education England, and Suzanne Rastrick of NHS England and NHS Improvement.