At the time of writing, the professional and general media has been alive with debate about the impact of the Francis Report one year on. The arguments about staffing levels within hospital wards continue to be strongly deliberated, with many asking for a minimum nurse-patient ratio to be set. The difficulty is that the level of patient need may not be reflected in the minimum, leading to potential challenges when more nurses are needed in response to patient need.
Professional judgement is required by the leader of the clinical area in determining the number of staff needed on duty at any one time. This includes accounting for each team member's level of competence, experience, development and specialist training - factors which cannot be included in a basic ratio of nurses to patients.
One issue that has been agreed upon is that wards should display publicly live data on the numbers of nurses and nursing assistants on duty at any one time, to give a measure of assurance to patients and families that wards are adequately staffed.
While the focus of staffing levels is on the hospital environment, there is a separate issue of equal importance about the allocation of staff time to patients cared for in their own homes.
I recently listened to File on Four on BBC Radio 4, which examined the time allocated for social carers to visit patients at home to provide basic care, including helping older people to wash and dress, and assisting with medication.
The programme provided evidence that it is impossible to provide quality care in 15 minutes. Carers articulated the challenges involved, the access issues (three of the 15 minutes taken to open the key safe and gain access to the home of an older housebound person) and the travelling time needed, often not factored in by managers planning daily schedules.
As we continue down the path of better understanding the matching of staff to patient need, the nuances of the community environment in which nurses and carers work must not be forgotten.