One of the most pressing issues for nurses arising from the Francis report into care failings in Mid-Staffordshire is staffing levels. This has led to debate at the highest level and a clear position is emerging from the government: no mandate, no ratios; local decision-making by clinical managers, based on local need.
Last week, this position was reiterated by health minister Dan Poulter during a conference on patient safety, hosted by independent health charity the King's Fund: managers must account for levels of acuity and care needs of patients and match the staffing levels accordingly.
In the community however, life is a little more complex. Patients live miles from each other and the geography of the district covered by nurses must be accounted for when planning and allocating caseloads. Patients cannot be seen and assessed at a glance; it is not until the community nurse has visited the patient in their home, seen the circumstances in which they are living and undertaken a full assessment, that the level of skilled nursing care required can be confirmed.
There are many more variables to take into account in community settings, when determining the size, shape and skill mix of the district nursing team. Risk management is a major factor and this also has to be approached differently from the hospital setting.
I am therefore delighted to hear that, in Scotland, a tool has been developed to help calculate the number and levels of staff needed in community nursing teams. It will be introduced from May this year. I have asked to see the tool, with a view to sharing it with community nurses in other countries of the UK.
I am trying not to get too excited about its potential as it is unlikely that a single tool would be the panacea for an age-old problem. However, I hope it will be the catalyst to start an informed debate, which will lead to the robust commissioning of community teams with a combination of the right nurses with the right skills to meet the patients' needs.
Crystal Oldman, chief executive, Queen's Nursing Institute