Mairi McConnochie of our Healthcare Staffing Programme reflects on last week’s World Patient Safety Day, the challenges ahead and the successes we need to continue to build on.

The theme for this year’s ‘World Patient Safety Day’ was ‘Safe Staff, Safe Care’. In the wake of the COVID pandemic, this theme conjures up images of PPE-clad healthcare workers doing their best to create a safe environment and provide care to patients and service users under considerably trying conditions. But what if we look to the broader landscape of safe workforces?  There is much evidence to demonstrate a strong link between safe workforce levels and patient outcomes. A recent European study by the Registered Nurse Forecasting System (RN4CAST) identified that each additional patient per nurse is associated with 32% higher odds of poor quality care. Another RN4CAST study identified that for every 10% increase in the amount of care left undone, there is a 16% increase in the likelihood of a patient dying following common surgery.

There are challenges with shortages in the health workforce in many parts of the world, with the WHO estimating a global shortfall of 18 million healthcare workers by 2030.  The situation in some low income countries, such as Uganda where there are 1.6 doctors per 10,000 of the population, contrasts starkly against the more favourable situations in the UK and other high income countries. However, ensuring safe staffing levels is more than about balancing the demand and supply figures – it’s about making sure that the right people with the right skills are in the right place at the right time.

Scotland: leading the way

In this area, Scotland is leading the way by enshrining safe staffing in law. In 2019 the Health and Care (Staffing) Act was passed which requires health boards to adopt particular workforce and workload planning strategies. Using a range of workload planning tools alongside their professional judgement, hospitals, community services and care homes now have to look very closely at which kind of practitioners they should have where and when, to meet the needs of the patients or service users in their local context and to mitigate or escalate risks. At Healthcare Improvement Scotland, the Healthcare Staffing Programme is helping NHS boards carry out better workload and workforce planning so they can meet the obligations of the Act. We do this through training, staffing tools and methodology development and through offering tailored support and guidance to boards. The end goal is to empower boards to be able to re-design services to help ensure they are providing safe care.

Pandemic brings requirements into sharp focus

Never has this need been more pertinent than over the past few months when services have had to dramatically re-shape to handle COVID patients and everything that an infectious disease outbreak brings. Health Care Staffing Programme team members worked within the Chief Nursing Officer’s Directorate (CNOD) at Scottish Government during the peak of the COVID-19 pandemic on the development of staffing templates for use during COVID and immediately post-COVID in various environments such as Care Homes and Community Nursing settings. Team member Nancy Burns devised the Care Home Safety Huddle template, which went live in August, and now has over 1000 care homes across Scotland registered to use it.

Staff absences and an inconsistent approach to workforce planning have increased the pressure on Care Homes during the pandemic. At the same time, Homes were also expected to report a raft of information for various sources. The template aims to provide an overview of individual care homes for care home managers, Boards and Health and Social Care Partnerships to understand, intervene in and mitigate any areas of risk as they emerge. It also offers a clearer national picture of care homes and any emerging issues that require a national response, and allows easier reporting, freeing up vital care home resources.

Turning the spotlight on safe staffing

Now bringing this experience back with them, the programme team is building on these Scottish Government templates to ensure they are robust and have longevity for service delivery after the immediate post-pandemic phase.

The emergence of COVID 19, combined with this new government legislation, have both turned the spotlight on the importance of safe staffing for safe care. Now more than ever we must pay close attention to how best to use our workforce as we ride out this pandemic and we must use this opportunity and momentum to bed in new ways of working and allow innovation to flourish.

Find out more about the Registered Nurse Forecasting Studies:

Find out more about the WHO’s health workforce statistics:

Mairi McConnochie is Programme Manager with the Healthcare Staffing Programme of Healthcare Improvement Scotland.