Staffing levels and skill mix

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Staffing levels and skill mix, in particular in acute hospitals, was highlighted as a key area of concern for patient safety by the Mid Staffs Inquiry (aka Francis Report). This page brings together resources to support commissioners in these areas.

  • Submit your suggestions for inclusion here.


  • Key policy drivers
  • Publications & tools
  • Datasets
  • Specific service areas
  • Database search terms

Key policy drivers:



Specific service areas:

  • Acute services

Papers from NHS Improvement

  1. Safe staffing for adult inpatients in acute care, Dec 2016
  2. Evidence from NHS Improvement on clinical staff shortages A workforce analysis, Feb 2016
  • Children and young people

Defining staffing levels for children’s and young people’s services, RCN August 2013 and accompanying document A background report on nurse staffing in children’s and young people’s health care, RCN June 2013

  • Elderly care services:

FTN Benchmarking Briefing: Driving improvement in elderly care services, Foundation Trust Network 2012 This benchmarking report  compares how care pathways for older patients are delivered and managed across 16 acute trusts. The workforce and Costs section (page 8) notes the significant variation in both the number and mix of staff on dedicated elderly care wards.

The impact of workforce flexibility on the costs and outcomes of older people’s services: A policy and literature review. Nancarrow, S et al Report for the National Coordinating Centre for the NHS Service Delivery and Organisation (NCCSDO), July 2008. This large study of community and intermediate care services for older people investigated the impact of different staffing configurations on outcomes for patients, service use and costs and staff satisfaction.

Safe staffing for older people’s wards: RCN summary guidance and recommendations. RCN,2012

  • Emergency Care

NHS Improvement – Safer, faster, better – transforming urgent and emergency

College of Emergency Medicine – Safe staffing

  • Intermediate Care

The relationship between staff skill mix, costs and outcomes in intermediate care services.Dixon et al. BMC Health Services Research 2010, 10:221

  • Learning Disability 

NHS Improvement – Safe staffing in learning disability services

  • Maternity services

Reconfiguration of women’s services in the UK (RCOG 2 January 2014) – An outline of the standards that should be applied when women’s services are reconfigured. It focuses on workforce planning including obstetric staffing, size of unit, geographical access to units, education and training. Searching the literature: Search NHS Evidence for recommended for staffing levels Search the databases:

HMIC Medline BNI
  • exp MEDICAL STAFF/supply & distribution
  • exp NURSING STAFF/organisation, supply & distribution
  • PERSONNEL STAFFING AND SCHEDULING (Consider adding subheading SD)