NICE, or the National Institute of Clinical Excellence is studying the issue of minimum staffing levels of nurses and doctors on our wards and is shortly to publish its report.

It is speculated they will advise a minimum ratio of one nurse to every eight patients on a ward. The issue has come to the forefront because one of the main causes of the problems at Mid- Staffordshire hospital was the lack of enough nurses on the ward.

This is a complex issue to get right because the type of patient and their needs determine what safe nursing levels are, and that changes and is hard to predict.

On an orthopaedic ward, an elderly patient with a fracture neck of femur needs much more intensive nursing than a young man with a broken wrist. Predicting how many of each are going to get admitted is difficult. Staffing levels cannot be increased quickly in our current system and flexibility is lacking.

Even if hospitals wanted to hire more nurses, they are not easy to find. They also cost money which overstretched hospitals do not have. It is however a step forward in the right direction to improve the quality of care in our hospitals.

NHS BEDS SHORTAGE

The Organisation for Economic Co-operation and Development has published a report showing that Britain has 2.95 hospital beds per 1,000 people, compared to 6.37 in France and 8.27 in Germany.

The OECD average is about 4.5. On the one hand this means we have a cost-effective system delivering great value for money. It also means the system is overstretched on occasion and ambulances have to queue to get patients into A&E, planned operating lists are cancelled, it is sometimes difficult to find a patient a bed and hospital bed managers have a really stressful job.

Every winter the pressure on the system increases and there is no slack in it. As the population ages and the demands on the system increase, the problem is going to increase.

How are we going to cope? With the population static at 60 million, health care spending increased from £33.5 billion in 1997 to £110 billion in 2010/11. How much more can we spend? Surely, more money cannot be the solution.

One solution is for the Government to invest in disease prevention and to promote healthy lifestyles through media campaigns.

All my GP colleagues say that people who live healthy lives hardly ever use the NHS system.

SUMMER IS UPON US - BEWARE!

With the sun blazing this weekend, as I write this I feel wonderful and spent all day outdoors - cutting the grass, on a bike ride and just mooching in the garden. It is timely perhaps to remind ourselves of all the problems summer brings and a few precautions we could take.

Mowing injuries are common and injuries to toes and fingers keep A&E departments busy. Keeping children away while we are mowing the lawn is a good idea.

Dehydration is common - you will feel dizzy, light-headed and your mouth tastes of cotton. Drink plenty of water and schedule time in the shade. With the blazing sunshine comes the risks of sunburn so cover up, wear hats, and put on sun cream.

Just five sunburn episodes doubles your risk of melanoma. Some people have life-threatening allergies to stings. Experts advise avoiding heavy floral perfumes, wearing light-coloured clothing and covering up sugary foods and drinks when outdoors.

If you get stung and get itching or swelling over larger areas of your body, difficulty breathing, swelling of the tongue or face or dizziness - go to the nearest A&E department.

Manoj Krishna is a spinal surgeon working at the Nuffield hospital in York. For more information visit www.spinalsurgeon.com