How to ensure the right people, with the right skills, are in the right place at the right time

High quality, compassionate care is about people, not institutions. In every ward and clinic, in every hospital, health centre, community service and patient’s home across the country, nursing, midwifery and care staff work to provide care and compassion to people when they need it – whether it is at the beginning, or end of their life; in times of illness or uncertainty; or as part of helping people with long term conditions to stay as healthy and live as independently as possible.

However, there have been examples of care in recent times which have been unacceptable. These have been as a result of individual and organisational failings. We must all find the provision of sub-standard and unsafe care to patients intolerable. We must do all we can to support our staff to provide high quality, compassionate care. And we must support organisations to be able to make the right decisions about their staffing needs and to create an environment within which staff are supported to care.

This guidance, which I have developed with my colleagues from the National Quality Board, seeks to support organisations in making the right decisions and creating a supportive environment where their staff are able to provide compassionate care. It sets out expectations of commissioners and providers in relation to getting nursing, midwifery and care staffing right so that they can deliver high quality care and the best possible outcomes for their patients. To a large extent, these expectations are about common sense and good leadership. We expect that all organisations should be meeting these currently, or taking active steps to ensure they do in the very near future.

There has been much debate as to whether there should be defined staffing ratios in the NHS. My view is that this misses the point – we want the right staff, with the right skills, in the right place at the right time. There is no single ratio or formula that can calculate the answers to such complex questions. The right answer will differ across and within organisations, and reaching it requires the use of evidence, evidence based tools, the exercise of professional judgement and a truly multi-professional approach. Above all, it requires openness and transparency, within organisations and with patients and the public. This guidance helps organisations to make those decisions by identifying tools, resources and examples of good practice. NICE will soon review the evidence and accredit evidence-based tools to further support decision-making on staffing.

Getting the right staff with the right skills to care for our patients all the time is not something that can be mandated or secured nationally. Providers and commissioners, working together in partnership, listening to their staff and patients, are responsible and will make these expectations a reality. As national organisations we pledge to play our part in securing the staffing capacity and capability you need to care for your patients.