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We understand your challenges

There are systems available to help you roster your staff and then react to issues on the day, but we believe there is a gap at the very beginning of the staffing process – in planning and standardising what you need, appraising care levels across the week, and identifying where you can make savings safely – whether you’re an NHS trust, hospice or private provider.

We recognise the challenge that lies in balancing budgets with safe staffing, and designed Establishment Genie to help you navigate this as a team, understand how competing priorities interact, and make informed decisions underpinned with detailed data and reports.

Take stock of your staffing, compare care levels and costs within your organisation and with peers, and remodel for safe, affordable care – backed up by comprehensive, automated reporting.

"As a Trust we have welcomed the introduction of Establishment Genie. The tool has enabled us to engage with our ward managers and matrons directly in the review and later setting of establishments. This work has reinforced some of our thoughts and challenged us in other areas, allowing benchmarking of specialties and divisions, taking away the hours of hard work, simplifying the mystique and enabling clear reporting to our own Trust and external partners. Thank you.“ – Vanessa Sloane, Director of Nursing, Chelsea and Westminster NHS Foundation Trust.

Assure your care levels and deliver savings safely

The Genie is an easy, online tool that helps senior nurses and midwives, in partnership with their finance, HR and operational colleagues, to review, compare, remodel and report their establishments.

  • Evaluate your establishments and remodel to improve safety or cost
  • Deliver cost reduction safely and articulate the relationship between budgets and care levels
  • Identify the exact WTE requirement and uplift for each ward and compare this to the budget
  • Prepare for, or respond to, inspections by the CQC and other regulators
  • Overlay staffing levels with quality indicators to explore trends between staffing and outcomes
  • Explore better, cheaper ways of meeting fluctuations in demand, bed numbers and patient mix
  • Save time and improve the quality of your monthly and six- monthly safe staffing reports
  • Demonstrate compliance with recommendations from the Francis Inquiry, Carter Review and the NQB
  • Model the workforce for new roles (e.g. Band 4 Nursing Associates), mergers or reconfiguration of services

The Genie drives workforce planning in line with the Francis recommendations, highlights unwarranted variation in response to the Carter review, and supports the National Quality Board’s directive that workforce planning should be based on ‘collaborative decision making between clinical and managerial staff, reporting to boards.’

Try the Genie for free

See how it can work for you – contact us for a free diagnostic review that is yours to keep with no obligation. We’ll work with three of your wards (or for hospices, your entire organisation) in just one day and show you the difference Establishment Genie can make.

"It was easy to review our staffing using the Genie and the reports give real insight. I can really see how it can help our hospice plan and budget for the care we need to deliver." – Maddy Bass, Head of Nursing and Quality, St John’s Hospice, Lancaster.

About Us

Creative Lighthouse Ltd (CLL), the makers of Establishment Genie, supports senior nurses, midwives and their colleagues to review, plan and budget for safe, affordable nurse and midwifery staffing – that’s all we do.

CLL was founded by Richard Cooper and Eve Mitchell – former NHS managers with a specialism and focus on helping professional leads articulate the staffing their wards need to be effective and safe. Collectively, we’ve worked in partnership with senior staff from ward to board across dozens of healthcare providers in the UK, Australia and New Zealand. We ground our work in our broad spectrum of experience gained from delivering wider healthcare improvement since the early 2000s.

Our objective is to empower and complement professional judgement in decision making and budgeting. We do this by providing clear metrics, benchmarking and reporting to describe the care levels and cost of current or alternative establishments. We distilled our experience of what providers find helpful into an automated, self-service online tool – the Establishment Genie.

We are committed to making a positive contribution to healthcare and we’re grateful to those we work with along the way. In recognition of the often superhuman service that nurses, midwives and healthcare assistants provide, we have pledged to donate 2.5% of our annual profits to the Cavell Nurses Trust. See their work here:

"Establishment Genie has made a difference to morale already in the high level findings. You made the whole process achievable and interesting. The Genie is FAB!! Thank you." – Fiona Blackwell, Divisional Nurse Director, Medicine, Wye Valley NHS Trust.

Contact Us

We’d love to talk to you. Get in touch to arrange your free diagnostic, to hear client testimonials, and to discuss your requirements: 0800 689 0215

Commissioners, Regulators, Policy Makers and Researchers

What is it?

Establishment Genie is an online tool that supports senior nurses and midwives, in partnership with their non-clinical colleagues, to review, compare, remodel and report their establishments.

From working with 30 hospitals in the UK, Australia and New Zealand on nursing workforce reviews, we saw an opportunity to create something to help providers take stock of care levels, plan and remodel for safe staffing, and articulate the budget required to deliver this. The challenges that these organisations shared with us included:

  • Ward-level workforce analysis available to senior nurses and midwives to enable and justify decision making was of variable scope and quality. This disadvantaged the professional voice in trustwide planning and debates.
  • Different providers used different staffing metrics when reviewing their establishment – and the same metric could be calculated differently from trust to trust. This compromised comparison and reporting accuracy.
  • A push-and-pull relationship between safe staffing and budgeting, and a lack of common ground from which to approach this as a shared, corporate issue.
  • Guidance on how and what to report in order to demonstrate ‘safe staffing’ and meet the monthly and six-monthly reporting requirement was regarded by many as light. There is significant variation in what trusts publish and considerable time is spent by senior staff on producing the outputs. 
  • Certain workforce cost reduction approaches risked false economies and placed hidden pressure on safety, budgetary control and the ability to cover 24/7 services.

There are a number of tools to help trusts roster their staff and respond to staffing issues on-the-day, but we believe there is a gap in detailed, integrated planning and budgeting at the very beginning of the staffing continuum. We designed Establishment Genie with this in mind, and consulted with experts and piloted with providers over 12 months to develop our approach.

What do providers use Establishment Genie for?

  • Taking stock of establishments and remodelling to improve safety or cost
  • Delivering cost reduction safely and articulating the relationship between budgets and care levels
  • Identifying the exact WTE requirement and uplift for each ward and comparing this to the budget
  • Preparing for, or responding to, inspections by the CQC and other regulators
  • Overlaying staffing levels with quality indicators to explore trends between staffing and outcomes
  • Exploring better, cheaper ways of meeting fluctuations in demand, bed numbers and patient mix
  • Saving time and improving the quality of monthly and six-monthly safe staffing reports
  • Demonstrating compliance with recommendations from the Francis inquiry, Carter review and the NQB
  • Modelling the workforce for new roles (e.g. Band 4 Nursing Associates), mergers or reconfiguration of services

What does Establishment Genie mean to me?

The Establishment Genie is for use by senior nurses and midwives in collaboration with their non-clinical colleagues, but we envisage benefits for other stakeholders and audiences:

Researchers and Policy Makers

We hope the reports that trusts publish, and the bank of ward-level data that will build over time from data being collected and analysed in a uniform way will be of benefit to the profession. Our clients frequently ask what is a ‘good’ score for staffing metrics like Care Hours per Bed Day – we hope that the cumulative use of the system, and the ability to compare, will help hospitals to decide what ‘good’ means to them. See our page on Clients & Case Studies, or contact us to discuss your policy-related interests or questions.

Regarding the other workforce and rostering tools available, we have designed the Establishment Genie to be complementary to these, to address what we perceive as a gap in the workforce planning continuum. We actively recommend that our clients triangulate the outputs from the Genie with outputs from other tools, and we provide a list of examples on our Policy & Practice page.

We would like to partner with individuals or organisations to research and appraise the impact that the Genie may have over time on the organisations that use it. Please contact us if you are able to help.


As a key audience of the monthly and six-monthly safe staffing report that all trusts must publish, the Genie can improve the clarity and scope of the information you receive. You have the assurance of knowing the outputs have been calculated in a consistent way, which aids comparison across all trusts that you commission or benchmark against.

The metrics integrate safety and cost, and offer a value for money perspective on the workforce. If you have a special interest in a particular performance issue or patient outcome, you can request that your partner trust(s) include show this outcome against their staffing data. Consistent formats and metrics from one report to the next allow you to track progress over time. The facility to remodel for different scenarios (e.g. winter beds, changes in activity, reconfigurations, etc) enables balanced discussions around workforce costs and capacity. 


Providers may use Establishment Genie reports to demonstrate the approach taken to assure nursing and midwifery planned staffing levels. By applying local or national staffing guidelines (e.g. nurse to bed ratios in paediatrics, etc), any times in the week where desired standards are not met will be highlighted.

Trusts may also use the Genie to react to action points raised in inspection reports. If staffing levels or skillmix are revised in response to CQC findings, the Current and Proposed reporting feature can articulate this transition, and overlaying outcome data against staffing metrics may help to demonstrate the improvements in patient care that result.

We’re always happy to receive feedback, explain our approach in more detail and discuss how the Genie could be of value to your interests. Please contact us to find out more.