In response to the Francis report this week, the Health Secretary is expected to say that the cause of the high mortality rates at Mid-Staffs’ was a management culture that permitted poor lines of accountability and traded operational targets for compassionate care on the front-line (Calkin 2013).

However, while the Francis report lists the evidence of failure, I believe it fails to tell the narrative that we all know: that while there remains no official guidance on staff/patient ratios (RCN 2010) cost cutting will continue to be achieved through a reduction in qualified staff and an increase in untrained staff; resulting in less able staff, delivering more complex care, to sicker patients, in shorter delivery times.

Any nurse will tell you that this sort of strategy is lethal (UNISON 2009): the increased levels of stress quickly turn into higher rates of sickness absence, leading to more pressure on less staff, more agency workers, higher staffing costs, less continuity of care, poorer record keeping, less resources for training, less knowledge and experience, less organisation, lower morale, more fatigue, less compassion and more patient safety incidents.

The medicine for this malady is not rocket science: health and safety legislation already requires all UK organisations to monitor their sickness absence records and regularly review their action plans (Health and Safety at Work Act 1974). Hunt should recommend that NHS boards must lead the way on reducing sickness absence as a major public health initiative (NICE 2009); this would unite the NHS’ strategic and operational objectives; not divide clinicians and administrators into politically antagonistic factions within an organisation, as witnessed and abhorred by Francis.

If we are really going to learn from these mistakes then Hunt should also take the opportunity of revitalising health surveillance systems, to create a 21st century hospital environment. New technology is available that feeds clinical data directly into clinical governance systems (e.g. University of Leicester 2011, University of Oxford 2012, Oregon State University 2012); if this technology were reproduced in the areas of deficit noted by Francis: nutrition, fluid balance, digestive processes, pressure sores and excretions, it could lead to the automatic recording of early warning systems, making the investigation of critical incidents easier, and freeing up nursing staff to do what they are good at – good old bedside care and compassion!


Calkin, S. (2013) Health Secretary Hints at Mid Staffs Report Response, Nursing, 31 January, 2013

University of Leicester (2011) Ground-breaking technology will revolutionise blood pressure measurement for first time for over a century.

Oxford University (2012) Spin-out tech checks vital signs by webcam

Oregon State University (2012) Medical Vital-Sign Monitoring Reduced to the Size of a Postage Stamp 

National Institute for Clinical Excellence (2009) Promoting Wellbeing at Work (PH22)

Health and Safety at Work Act (1974)

Royal College of Nursing (2010) Guidance on safe nurse staffing levels in the UK 

UNISON (2009) Stress at work: A guide for UNISON safety reps

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  1. Brian Fisher says:

    Can you explain more abt the technology?

  2. Steve Adshead says:

    The movement towards ‘virtual wards’ in general medicine and monitoring of dementia patients at home in psychiatric medicine has led to the development of a range of technologies that feed data back to remote systems that can be used as standard nursing instruments. In the piece above I reference new technologies regarding vital signs. However, I should have said ‘could eventually’ feed into live clinical governance systems, rather than ‘are’, because these things seem to be at the design prototype stage, rather than in mass production yet. The government is working hard on regulating the market in this area so all digital systems will be able to talk to each other (I don’t have a reference to hand for this but its in the last year). As a quality accountant in my own trust we developed a measure of staff patient ratios (using payroll returns and minimum data set figures) and were starting to take this another stage further, by integrating it with the updating of risk by front line staff in response to safety incidents on electronic patient records. This was going to give the directors good quality information on the changing stresses over the entire organisation, and the emerging manpower issues, covering a patch of 300 or 400 square miles. The staff would also be able to get this data fed back on to dashboards on their own PCs so they could see their work having an immediate effect; research suggests this should increase staff engagement and increase feelings of control and security thus reducing stress and absence. I left to join the University before the project was completed though.

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