Introduce legally enforceable safe nurse-to-patient staffing ratios in the NHS

Make minimum staffing levels a legal requirement by introducing national nurse-to-patient ratios that can help guarantee patient safety and protect staff wellbeing.

We believe recent government cuts have worsened understaffing issues, pushing services to a tipping point. Patients can be left waiting, care can be rushed, and harm can occur. There are reports of nurses burning out and leaving in record numbers. We feel unsafe care has become normal and is endangering both patients and staff. We think action is urgently needed to protect lives and sustain the NHS.

Fixed nurse-to-patient ratios are not enforced in England. The responsibility for staffing levels remains with clinical and other leaders at a local level, responding to local needs, supported by guidelines set by national and professional bodies and overseen and regulated by the Care Quality Commission (CQC).

This is particularly important in community nursing settings, where a simple numeric ratio does not adequately capture the complexity of safe staffing. Unlike inpatient environments, community nurses work across dispersed caseloads, often as lone workers, with significant variation in patient acuity, geography, care complexity and travel time. A flexible, evidence-informed approach to caseload weighting and workforce planning is therefore essential to reflect the realities of community care delivery.

Providers must systematically determine and review staffing and skills to meet service users’ needs and ensure patient safety, following legislation and available guidance.

Reaching the right staff numbers and mix should depend on an evidence-based approach and the exercise of real-time, risk-assessed, professional judgements by day-to-day leadership and a multi-professional approach.

The CQC checks for compliance with regulations that require regulated providers to have enough suitably qualified staff, and can take enforcement action where incorrect staffing levels are having an impact on patient outcomes.

National Quality Board (NQB)

Guidance from the NQB entitled Safe, sustainable and productive staffing (2016, available online at https://www.england.nhs.uk/wp-content/uploads/2013/04/nqb-guidance.pdf) and Developing Workforce Safeguard (2018, available online at https://www.england.nhs.uk/wp-content/uploads/2021/04/Developing-workforce-safeguards.pdf) is designed to ensure a consistent, scientific and evidence-based approach to staffing levels and to improve governance and board accountability relating to staffing decisions.

The approach combines evidence-based tools, professional judgement, and outcomes to ensure appropriate staffing and minimise patient safety risks.

It is important to note that NQB guidance primarily addresses acute inpatient care. For community nursing, NHS England supports specific staffing tools to assess caseloads, and ensuring their widespread use is a priority.

While England’s approach to safe staffing is through a combination of locally led decisions, evidence-based tools, professional judgement, regulatory oversight, and national guidance instead of fixed ratios, the Government will continue to monitor international evidence for workforce planning.

The 10 Year Health Plan and staff

This Government is committed to publishing a 10 Year Workforce Plan to set out action to create a workforce ready to deliver the transformed service set out in the 10 Year Health Plan. The 10 Year Workforce Plan will ensure the NHS has the right staff, with the right skills, in the right places.

NHS staff told us through the 10 Year Health Plan engagement that they are crying out for change. Our new Workforce Plan will set out how we will deliver that change by making sure that staff are better treated, have better training, more fulfilling roles, and hope for the future.

For our staff to care for people, the Government must also support staff. We aim for a sustainable workforce, focusing on training, working conditions, and restoring pride and job satisfaction.

Nationally, we recognise that staff across the NHS have been under considerable pressure. We want to improve organisational culture and working conditions so that we can keep staff healthy and motivated and retain vital skills and experience in the NHS.

From April 2026, we will introduce new minimum staff standards, focusing on key areas for staff wellbeing. Developed with the Social Partnership Forum, these standards will put staff wellbeing at the heart of the workforce model.

It is important that NHS staff work in an inclusive, compassionate environment with support for their health and wellbeing. The 10 Year Health Plan will introduce Staff Treatment Hubs providing high-quality occupational health support, including for mental health and back conditions.

NHS staff needing specialist mental health support can access NHS Practitioner Health, a national service for complex issues like trauma or addiction.

NHS staff are dedicated to making a difference, so we must support them with training and ensure a rewarding, inclusive work environment.

NHS England’s retention programme supports staff with occupational health, flexible working, better culture and leadership, and guidance for managers, new joiners, and those experiencing menopause.

By prioritising staff wellbeing, development, and retention, we will build a resilient NHS workforce equipped to deliver outstanding care for years to come.

Department of Health and Social Care