We have long been concerned about a lack of national guidance on staffing levels, nurse:patient ratios and skill mix in care homes. In the briefing Persistent Challenges to Providing Quality Care, we called for 'national guidance on staffing levels and ratios for care homes, determined and applied locally according to the dependency and needs of residents in a home’s care and to the demands of the home’s day (early and late) and night time shifts'.
In the absence of national guidance and ratios, the RCN’s Guidance on Safe Nurse Staffing Levels in the UK provides general principles for appropriate staffing that can be used in care homes across the UK.
The document includes some guidance questions that should be used when considering concerns about staffing levels in care homes. Once you have considered all these questions you will have a better idea of whether the needs of the patients are being met. Contact us for help in preparing a clear and objective statement of concerns to put to your employer.
Different regulators also set guidance/minimum standards for nursing and care homes across England, Northern Ireland, Scotland and Wales:
Nursing and care homes in England are regulated by the Care Quality Commission (CQC). CQC is the independent regulator of all health and adult social care in England provided by the NHS, local authorities, private companies or voluntary organisations. Providers must meet the 28 regulatory outcomes and essential standards as part of the registration process.
Standards are set by the Department of Health.
The Regulation and Quality Improvement Authority (RQIA) regulates independent health care providers, residential care homes and nursing homes.
RQIA has produced a range of standards which include guidance around staffing levels.
The Care Inspectorate registers services who must continuously meet the requirements of The Public Services Reform (Scotland) Act 2010, the National Care Standards, and any other legislation relevant to that service.
The Care and Social Services Inspectorate for Wales (CSSIW) regulate care homes for adults – including care homes which provide nursing care. CSSIW inspects against national minimum standards for care homes for older people and care homes for younger adults, which are available from the CSSIW website.