You'd think it would be simple. For the NHS it's a bread and butter issue. An absolute bog-standard, no-brainer. Meat and two veg.

How many nurses does it take to be sure patients are looked after safely?

When you fly away on holiday the numbers of cabin crew to passengers is a ratio prescribed in law. If you leave your kids in a crèche; the child to care assistant ratio is a matter of law. If you go to a football match the ratio of stewards to spectators is a matter for the law.

If you are a lorry driver the number of hours you can be behind the wheel is a matter for the law. If you are an airline pilot your flying hours are governed by the law.

If you are a nurse you can do back to back twelve hour shifts and might end up looking after ten, maybe twelve people, per session. Provided none of the patients soils the bed and they all get their pills on time we are OK.

Before a lorry driver, an airline pilot, a steward, a care assistant and cabin crew start work they sign on, sign in and someone does some counting.

If you are a nurse I suppose you count on good fortune, kiss your lucky rabbit's foot and hope for the best.

And then there is NICE; Safe staffing guidance, produced by NICE, is useless. They say (in terms) 1:8 might be right but if there are 'red flag' incidents then it is not enough. Red-flag incidents; bed soiling, meals not eaten and drugs not delivered on time. In other words; if care breaks down get some more nurses.

NICE said they couldn't find any evidence. I say; go on a ward in a DGH and ask the nurses.

It came as no surprise to me the job was taken away from NICE. In a fit of teenage harrumph NICE threatened to publish their new stuff on safe staffing, anyway. They are independent, why not.

The Carbuncle said they wanted to do safe staffing; to tailor it into service redesign.

The best the DH could do was a numpty spokeswoman who said; ... the government was "fully committed to making more staff available... if individual hospitals do not have enough staff to deliver safe care, the chief inspector [Sir Mike Richards] will step in and take action."

Well c'mon Richards; what are you going to do? Put yer underpants over yer trousers.  Now's yer chance to shine... deliver a box of nurses! Nah, you'll do what you always do; slag Trusts off, for not having enough nurses. What a super-hero...

Bart's in London has 1,200 nurse vacancies. Yes, you read that right; one thousand, two hundred vacancies.  One in five of its nurses and midwives.  What are you going to do about this Super Richards?  Taxi over and kick them, no doubt. 

The NHS can't decide how many nurses it needs to look after yer granny. The whole thing is an embarrassing, excruciating, humiliating mess.

In a new turn the HSJ's Hyperion, Shaun Lintern, revealed, what looks like pressure from the DH has resulted in NICE scrapping plans to publish safe staffing guidance for emergency departments. Bang goes their independence. What else does the DH meddle in?

For a business, whose business is looking after people, to squabble, row and dissemble over how many nurses it takes to do the business is beyond embarrassing. It is dumbfounding, stunning and undermines public confidence.

Except it is not. The truth is; we dare not find out the truth. As Lintern revealed earlier in the week, most Trusts are nowhere near hitting their staffing targets. There are not enough nurses and recruiting them from overseas is 'distracting, frustrating and expensive'.

HEE are doing something about it but to be honest, I can't figure out what.

To make it worse; Cameron's latest idea is to send home migrant workers who earn less than £35k. There go plane loads of nurses. The boy is a genius.

We dare not find out what levels of nursing are needed for safe staffing because we can't afford the answer. We can't afford to ask the nurses, we can afford to be honest... but for safety, quality and efficiency we can't afford not to.

The DH, the Carbuncle, NICE, HEE and the Treasury need to be taken into a small room and their heads banging together.

Shambles doesn't do it.

Have a good weekend.