Executive Summary
Staffing levels in the NHS are a key indicator for patient safety. Key government reports 1,2,3 over the last 15 years have highlighted significant failings in this area. NHS Improvement has worked on collecting data around Allied Health Professionals (AHP) staffing levels but much of this relates AHPs as a generic group. This guidance has been commissioned as a successor to the 2017 Safe Staffing Safe Workload Guidance document to provide both qualitative and quantitative information to help address staffing level concerns in clinical dietetic services across the UK across all settings
This document has expanded to include information on alternative means of service delivery, workload, stress and vacancy rates within services, reflecting the changes in working practices over the last 8 years. Newer roles have been included, such as Advanced Clinical Practitioners (ACP) and First Contact Practitioners (FCP). Job planning and practice (clinical) supervision within the workforce have also been reviewed. Service user complexity and the time required for a full dietetic consultation have also been considered.
The NHS published guidance on Job Planning, ‘Job planning: the clinical workforce – Allied Health Professionals. A best practice guide, July 2019’1 which categorises a professional’s workload into two main areas: Direct Clinical Care (DCC) and Supporting Professional Activities (SPA), with two other areas that are used occasionally; Additional Responsibilities and External Duties.
This document recommends that triangulation methods are used to take into account benchmarking figures on activities, capacity, capability, complexity and the safety indicators herein outlined. This combining of information sources enables a more reliable calculation of safe workload and safe staffing to support decision making. The accompanying toolkit and sister document ‘Workload Management’ 18 (to be updated in 2024/25) provide further guidance, together with the BDA ‘Influencing Action Pack’ can help to ‘make the case’ when increased staffing needs are identified. There will also be further guidance on Complexity to come in 2024 following a pilot study across the UK.
Introduction
This document focuses on the issue of safe workload and safe staffing levels within dietetic services. NHS staffing remains under scrutiny both internally and externally of the NHS.
The enquiry 2 into the Mid-Staffordshire NHS Foundation Trust and subsequent high-profile reports including that by Bruce Keogh 3 highlighted the risk to patients of not having the right staff with the right skills at the right time. This led to the 2013 National Quality Board (NQB) guidance 4 which set out expectations of commissioners and providers when managing local decisions around staffing to keep patients safe. The NQB recognises that staffing principles ring true across AHPs and the multi-professional workforce is included in the 2016 document’ supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time’ 5. The Model Health System is a data driven improvement tool to enable NHS health system and trusts to benchmark quality and productivity and identify opportunities for improvement so teams can continuously improve patient care. To aid this the NHS produced ‘NHS developing workforce safeguards’ ‘in 2018 6.
In 2023 the Health and Care Professions Council (HCPC) has 11006 registered Dietitians who have a professional duty to provide high quality, safe and effective care. Within the NHS, provider boards are accountable for ensuring that their organisations have the right culture, leadership and skills in place for safe, sustainable and productive staffing. In any healthcare provider service, there should be frameworks in place that incorporate a systematic approach to reporting and investigating safety incidents, including considering staff capacity and capability and act on issues identified. Within such frameworks, dietetic staff at all levels have a role in contributing to safe, effective responsive staffing levels. Dietetic managers and team leaders should nurture a culture that is supportive of peers including junior staff who raise concerns about workload or suboptimal staffing levels.
In order to help resolve and support these issues this document is part of a suite of documents to support dietitians and dietetic support workers to work through safe workload and safe staffing challenges in a holistic and pragmatic way.’ I suite provides figures and statistics as well as practical tools that are applicable to those working in clinical practice, whether employed by the NHS or elsewhere.
The suite of documents includes:
- Safe Staffing Safe Workload Guidance 2024
- 2023 Safe Staffing Safe Workload Project Report
- Safe Staffing Safe Workload Toolkit
- Workload Management (2017) – to be updated 2024/25
- Model and Process for Nutrition and Dietetic Practice (2021)
- Complexity Guidance - expected in 2024