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Towards safe nurse staffing in England’s National Health Service: progress and pitfalls of policy evolution

Towards safe nurse staffing in England’s National Health Service: progress and pitfalls of policy evolution
Towards safe nurse staffing in England’s National Health Service: progress and pitfalls of policy evolution
In 2013, a national inquiry into care failings at a large public hospital in England resulted in major healthcare reforms that included targeting policy aimed at ensuring the adequacy of nurse staffing levels on hospital wards within NHS England. This paper uses a review of publicly available documents to provide a contextual account of the evolution of nurse staffing policy development prior to and following the inquiry. We found that securing safe staffing policy has been impacted by caveats and competing policy, evidence gaps, lack of coordination, and the absence of readily implementable solutions. Consequently, five years on, safe staffing policy for NHS England is described in aspirational terms that ascribes accountability to providers, but fails to adequately address barriers to delivery. Kingdon’s ‘policy windows’ model is used to explain why policy, even when driven by strong public concern and with high inter-sector support, may struggle to gain traction when the conditions necessary for success are not present, and in the face of practical or political constraints. The progress and pitfalls encountered are not unique and the experience of safe staffing policy in England may have lessons for other countries grappling with policy development or implementation in this area.
Lawless, J.
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Couch, R.
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Griffiths, P.
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Burton, C.
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Ball, J.
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Lawless, J.
0b677431-9930-433b-a928-d149c2b8e0b8
Couch, R.
7d19650a-083d-4095-9518-940c2b6d0518
Griffiths, P.
ac7afec1-7d72-4b83-b016-3a43e245265b
Burton, C.
777daf74-8e6c-46f5-bc9e-97942cc3d19a
Ball, J.
85ac7d7a-b21e-42fd-858b-78d263c559c1

Lawless, J., Couch, R., Griffiths, P., Burton, C. and Ball, J. (2019) Towards safe nurse staffing in England’s National Health Service: progress and pitfalls of policy evolution. Health Policy. (doi:10.1016/j.healthpol.2019.03.011).

Record type: Article

Abstract

In 2013, a national inquiry into care failings at a large public hospital in England resulted in major healthcare reforms that included targeting policy aimed at ensuring the adequacy of nurse staffing levels on hospital wards within NHS England. This paper uses a review of publicly available documents to provide a contextual account of the evolution of nurse staffing policy development prior to and following the inquiry. We found that securing safe staffing policy has been impacted by caveats and competing policy, evidence gaps, lack of coordination, and the absence of readily implementable solutions. Consequently, five years on, safe staffing policy for NHS England is described in aspirational terms that ascribes accountability to providers, but fails to adequately address barriers to delivery. Kingdon’s ‘policy windows’ model is used to explain why policy, even when driven by strong public concern and with high inter-sector support, may struggle to gain traction when the conditions necessary for success are not present, and in the face of practical or political constraints. The progress and pitfalls encountered are not unique and the experience of safe staffing policy in England may have lessons for other countries grappling with policy development or implementation in this area.

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Towards safe nurse staffing in England’s National Health Service: progress and pitfalls of policy evolution - Accepted Manuscript
Restricted to Repository staff only until 19 March 2020.
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Accepted/In Press date: 12 March 2019
e-pub ahead of print date: 19 March 2019

Identifiers

Local EPrints ID: 429276
URI: https://eprints.soton.ac.uk/id/eprint/429276
PURE UUID: 57263700-ce1b-4c84-84b7-446be207eafe
ORCID for P. Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for J. Ball: ORCID iD orcid.org/0000-0002-8655-2994

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Date deposited: 25 Mar 2019 17:30
Last modified: 17 May 2019 00:32

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Contributors

Author: J. Lawless
Author: R. Couch
Author: P. Griffiths ORCID iD
Author: C. Burton
Author: J. Ball ORCID iD

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