The Francis Report and nurse staffing: A message to Jeremy Hunt

As editor of Evidence Based Nursing I, perhaps unsurprisingly, believe it is important that nurses use the best available evidence when making health care decisions. I also believe politicians should do the same when deciding on health care policy. When Jeremy Hunt took over from Andrew Lansley as the English Secretary for Health last September I hoped we would have someone in post who would both listen to what nurses were saying and make evidence-based decisions. However, this appears not to have happened.

A prime example of where evidence does not seem to be taken into account by politicians is their refusal to set minimum staffing levels for registered nurses in England. Over the last month there has been a lot of press coverage relating to current staffing levels. In April the Royal College of Nursing (RCN) announced that nine out of ten nurses in Scotland believe staffing levels are not always adequate to provide safe patient care (see:  Over a quarter (27%) of nurses in Scotland think staffing levels are rarely or never safe. Last weekend the Safe Staffing Alliance reported the results of a survey of just under 3,000 nurses at 31 English hospitals, which found that hospital wards regularly (at least 40% of the time) have one registered nurse caring for eight patients (see:  A poll carried out with 2,000 nurses for the Sunday Mirror and the Nursing Standard, also published last weekend, found that 40% of nurses said there were not enough staff to provide a safe level of care on their last shift (see: This survey also found that more than three-quarters of nurses believe a scandal similar to that at Mid Staffordshire Hospital could happen again.

Something appears to have gone dreadfully wrong in relation to nurse staffing levels in the UK. When I met a friend for a drink the other week we had to wait a long time to be served and the level of service was poor because there was only one member of staff on duty. Given the reduction in the nursing workforce it is hardly surprising then that the quality of care is falling. Indeed, there is increasing research evidence demonstrating the link between registered nurse staffing levels and the quality of care (e.g. Aiken et al. 2012).

One of the lessons of the Mid-Staffordshire Hospital disaster that Jeremy Hunt appears to have missed is the tendency of hospital managers to focus on nationally set targets such as the 4-hour wait in emergency departments to the detriment of other issues for which no such targets exist. The nursing workforce at Mid-Staffordshire Hospital had reached dangerously low levels as managers aimed to meet the financial targets required to achieve Foundation Trust status. If national minimum staffing levels had been in place and been audited at this time it is likely that different decisions may have been made in what had become a financial driven organisation. Despite this Jeremy Hunt and his ministers are still refusing to consider national staffing standards, repeatedly saying this is an issue that should be managed locally.

It is not that nurses don’t care but that all to often they are caring for too many patients. At RCN Congress last month exactly how much nurses do care was illustrated by a poem written by a nursing student in response to the battering the nursing profession was receiving in the press. This can be seen at:

So my message to Jeremy Hunt is to stop blaming nurses and nurse education for the ills of the profession and take note of the evidence. Instead of coming up with unworkable schemes such as all prospective nursing students undertaking a year as a health care assistant prior to starting their training take note of the real messages of the Francis report and set national standards for nurse staffing. You can find a summary of the evidence relating to minimum staffing levels at: However, if you continue to ignore the evidence in this context and do nothing about minimum staffing I believe we will see more Mid Staffs-like disasters.

Alison Twycross


Aiken, L.H., Cimiotti, J.P.. Sloane, D.M., Smith, H.L., Flynn, L. and Neff, D.F. (2012) Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Journal of Nursing Administration, 42(10 Suppl): S10-S16.


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