Posted By CFT I have not worked with the NHS (you don't say it is in fairness), but in recent years I did advise to private Hospitals, there was a chain of command much the same as any industry, can you not simply ask a superior? If this is difficult you must have reps working on some of the wards, can you ask them to bring it up in the future? Not knowing the level of care you are administering, 3 to 16 as a ratio, does not sound to me a major safety issue, but without further information, the rather more obvious 'health' one may be relevant; what have you done in the past, have things changed recently to give you cause for concern? CFT

Posted By Andy Brazier Concern over staffing levels is one that has affected many industries. For example, in the last 20+ years the number of people working at oil/gas/chemical sites has steadily reduced. The HSE became very concerned and commissioned a method to be used to assess staffing arrangements (available as contract research report 348/2001). It requires companies to consider hazardous scenarios and to make an objective assessment of how likely it is that the people present at the time will be to make a satisfactory response. We typically consider what would happen at 2am when staffing is usually at minimum, but also around 8-9am when there is a sudden peak of activity due to staff and contractors arriving. I have carried out a large number of assessments using the above method. Interestingly it is very rare that it is the number of people that determines the outcome of the assessment. It really depends on how quickly a situation is detected, how quickly it can be diagnosed, how well individuals work together (including communication), the availability of people to support, the quality of procedures etc. What I often say 3 well trained people who are able to work together will nearly always be better than 20 people who do not know what they are doing. I have often thought the principles of the method could be adapted for other industries. We did make a half-hearted attempt with the prison service, but could not find an easy road into the industry. In this case it may be easier to make a case that manning is low if you can make a clear justification based on what would happen during a 'credible' event. This is usually better than a straight comparison with other areas.

Posted By Jean Hello All I worked as a Risk Manager in the NHS. We had a community unit, which had more incident reports relating to slip, trips and falls than any other area in the PCT. Many of the patients were confused. As I had to review each of the incident report forms, I became very concerned and took it up with a more senior manager. The person on the unit was deemed to be a trouble maker for constantly reporting the low staffing levels. The arguement was that it was not cost effective to change the systems to any format other than the current one. Reason requires that the person receiving the information is receptive.