How many doctors does it take to staff a hospital? This might seem a simple question, but even asking it seems brave to some. What if the answer shows how few hospitals have safe medical cover? After the scandal of Mid Staffordshire, Robert Francis called on the National Institute for Health and Clinical Excellence to draw up safe staffing levels, to be policed by the Care Quality Commission. NICE has produced guidelines for the number of nurses needed but not for doctors.
The Royal College of Physicians has now taken up this challenge. As Matthew Limb reports (doi:10.1136/bmj.k3136), the college’s review, summarised in our accompanying infographic, gives indicative figures for how many person hours for junior, middle ranking, and senior doctors are needed in the assessment and admissions team, on a medical ward in the week and at weekends, and for day and night on-call cover in different sized hospitals. Where possible, the college has suggested the number of posts needed to cover these hours; crucially, these estimates recognise that doctors take annual, study, and sick leave. This basic fact hasn’t been properly accounted for in the past, says the college’s president elect, Andrew Goddard. And as for the cost of proper staffing, let’s not forget that the NHS spent £3bn (€4.4bn; $4bn) last year on locums. “The NHS already spends a lot of money trying to fill rota gaps and shortages and a lot of money trying to sort out problems when something’s gone wrong with patient care that could be prevented by having adequate staffing levels.”
The UK has fewer doctors and nurses per head of population than similar economies in Europe, write Azeem Majeed and colleagues (doi:10.1136/bmj.k3036). Tackling staff shortages will be key to improving outcomes in the NHS, they say. So too will integrating general practice and specialist services within one organisation, providing a single point of contact for urgent care, investing in specialty services, and improving the use of digital technology. And then there is the need to consider the wider determinants of health: housing, education, employment, and the environment. These social inequalities drive poorer outcomes, especially in children and elderly people, they say.
Few people have done more to highlight the effects of social inequality on health than Julian Tudor Hart, who died earlier this month (doi:10.1136/bmj.k3052). His lasting contribution was the “inverse care law,” the idea that the people who most need good medical care are the least likely to get it. It also says that this effect is strongest where medical care is most exposed to market forces and weakest where this exposure is reduced. As we ponder the future of the NHS, we would do well to remember this.

中文翻译：

---

安全人员编制

一家医院需要多少医生？这似乎是一个简单的问题，但即使对某些人来说似乎也很勇敢。如果答案显示有几家医院拥有安全的医疗保险怎么办？在中斯塔福德郡丑闻之后，罗伯特·弗朗西斯（Robert Francis）呼吁国家卫生与临床卓越研究所（National Institute for Health and Clinical Excellence）制定安全人员编制标准，并由护理质量委员会（Care Quality Commission）监管。NICE已针对所需护士人数（而非医生人数）制定了指南。
皇家内科医学院现在已经接受了这一挑战。正如Matthew Limb的报告（doi：10.1136 / bmj.k3136）所示，该学院的评估总结在我们的随附信息图中，给出了评估和录取团队需要多少人担任初级，中级和高级医生的工作时间的指示性数字，每周和周末在医疗病房中使用，在不同规模的医院中进行白天和黑夜的紧急求助。在可能的情况下，学院建议了这些时间所需的职位数量；至关重要的是，这些估计认识到医生请了年假，学习假和病假。该校校长安德鲁·戈达德（Andrew Goddard）说，过去没有适当地解释这个基本事实。至于适当的人员配备成本，我们不要忘记，NHS去年在游憩场所上花费了30亿英镑（44亿欧元； 40亿美元）。
Azeem Majeed及其同事写道，英国的人均医生和护士人数少于欧洲的类似经济体（doi：10.1136 / bmj.k3036）。他们说，解决员工短缺将是改善NHS成果的关键。在一个组织内整合一般实践和专科服务，为紧急护理提供单点联系，投资专科服务，以及改善数字技术的使用，也同样如此。然后，有必要考虑更广泛的健康决定因素：住房，教育，就业和环境。他们说，这些社会不平等导致了较差的结果，尤其是在儿童和老年人中。
没有比本月早些时候去世的朱利安·都铎·哈特（Julian Tudor Hart）更加突出社会不平等对健康的影响的人（doi：10.1136 / bmj.k3052）。他的持久贡献是“逆向护理法”，即最需要良好医疗护理的人获得此护理的可能性最小的想法。它还说，在医疗保健最容易受到市场力量影响的情况下，这种影响最大，而在减少这种影响的情况下，这种影响最弱。当我们思考NHS的未来时，我们会很好地记住这一点。