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DH is yet to refer vital staffing guidance work to NICE

The National Institute for Health and Care Excellence is yet to be asked to draw up evidence-based tools for establishing minimum safe staffing levels, six months after it was recommended by the Francis report.

Robert Francis QC’s public inquiry report on Mid Staffordshire Foundation Trust called for NICE to develop evidence-based tools to ensure safe staffing levels on a specialty by specialty basis, as an alternative to a national mandatory ratio.

In its initial response to the report in March, the government agreed to work with NICE on the recommendation.

A separate report for the government, published this month by US patient safety expert Professor Don Berwick, also backed the idea and stated that NICE should “undertake as soon as possible” work to develop the guidance.

But a spokeswoman for NICE said last week that, while it was aware of the issue, the work was yet to be “referred” to it by the Department of Health.

“The topic has not been referred to NICE, as yet. However, it is something that NHS England is looking at as part of its [national nursing] strategy Compassion in Practice,” she told Nursing Times.

A DH spokeswoman confirmed that it still intended to request NICE to carry it out. She said: “NICE will be asked to look at evidence-based staffing levels guidance and tools, but discussions are at an early stage.”

However, Jim Buchan, professor of health sciences at Edinburgh’s Queen Margaret University, said the lack of progress was “surprising”.

“They are not even at the starting block yet,” he said. “This is a significant job which would require a lot of resources if they wish to do this over a short timescale.”

He added: “We need tools that are relevant to the care environment; we need leadership locally that has the resources and responsibility to meet the levels the tools are demanding and we need some degree of professional responsibility and decision making at ward level.”

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Readers' comments (14)

  • It isn't surprising at all, Jim. In fact, it is perfectly in keeping with the Tory ideology (let's face it, the Lib Dems are an irrelevance) of the current government. When you are dismantling and privatising the NHS, it serves your ends to discredit the staff and make their jobs impossible to carry out safely. At the same time, it is important to ensure the public believe that it is entirely the fault of the staff (in particular, the legions of uncaring nurses) and vomit forth insane, pointless initiatives like the 6Cs and care champions. No need to ask those nice people at NICE to divert their attention to the trivial matter of staffing levels.

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  • tinkerbell

    if any nurses are left in any doubt that the plan is to erode the Nursing profession then this should speak volumes.

    I was hopeful that Nurses would stand up and be counted but sadly now I think this was just wishful thinking.

    If nurses aren't prepared to stand up to save themselves then no one is going to do it for us. We are, it seems, to become a rare species if not extinct.

    There is nothing more that I can say or do in my workplace that makes a happeth of difference so I have stopped banging on about it after 3 years of being met with resignation and still they moan on and on about stress levels and being over worked. If only that long moan were channelled into positive action.

    I have nothing more to add as it is just becoming inconsequential repetition. I hope Nurses of the future, if there are enough left, have a change of heart but for myself as they say in dragons den 'I'm out' ever hopeful that we might rally again at some future date.

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  • Regardless of who is in power, staffing will be an issue for as long as we, so-called
    professionals continue to sit back and let who ever is in power dictate to us, just how it is going to be. We, as a profession love to bitch and moan, but appear less in inclined to do something about it.
    Some of us are just too darned old and beaten down to do something about it, others are bullied into submission and the newer ones, have accepted the status quo already. Until we stand up and fight, nothing will change. So.......

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  • michael stone

    You can see the DH won't be keen on this one - but what does this mean ?:

    'A DH spokeswoman confirmed that it still intended to request NICE to carry it out. She said: “NICE will be asked to look at evidence-based staffing levels guidance and tools, but discussions are at an early stage.”'

    What discussions are at an early stage ? - NICE should simply be aske dto try and come up with a tool to evaluate staffing levels below which it almost inevitably 'becomes unsafe for patients'.

    Doubtless the DH wants to fix the question, so that 'we need more staff to be safe' doesn't come out as the answer - it isn't clear (at least to me) how the question can be 'rigged' tha tway: hence, presumably, why it is taking so long !

    And there is some 'form' on this, recently: when the DH asked Lady Neuberger to review the LCP, the brief was clearly 'to figure out how to repair the public's (damaged) perception of what the LCP was' - but the Review Team strayed well 'off-brief' by examining wider issues, and also by saying 'the LCP is tarnished beyond repair'. Which presents something of a problem, in connection with this staffing ratios tool, for the DH !

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  • Anonymous | 19-Aug-2013 1:34 pm

    "Until we stand up and fight, nothing will change. So......."

    .......what's your plan?

    This is a genuine question. I know (from previous posts) that the first two commentators have been out on strike in the past and often advocate industrial action for nurses to achieve their aims. Do you agree with this type of action? If yes, then how do we get other nurses off their backsides? If your answer is no, then what are your ideas? I've tried to motivate my colleagues but they don't ever want to get involved. Most are only in a union in case someone decides to sue them.But like Tinkerbell says, they sure know how to moan.

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  • For a start staffing levels should be subject to 'targets' and if sickness is left uncovered or vacancies left unfilled then the trust should be penalized. Its just too easy for managers to save money in this way with full knowledge that nurses will fill in the gaps while ignoring the risk to patient care.

    Okay so I don't want to strike, as a DN any gaps left in patient care will still be there when I come back to work and any deterioration in patient condition will result in more work for me when I get back.

    What can be done instead? Well mid staffs is what happened as a result - I would be happy to sign a disclaimer that would say 'I will not be held accountable for problems that arise from understaffing'. If we can firmly make it the responsibility of those who make the decisions on staffing then I do believe that the current practice of cutting staffing to make ends meet will be reduced. I think we have to fight targets with targets.

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  • Anonymous | 19-Aug-2013 7:08 pm

    "I would be happy to sign a disclaimer that would say 'I will not be held accountable for problems that arise from understaffing'."

    Good luck trying that one. No disclaimer will ever be made available for you to sign. If you try to use low staffing as a reason for something going wrong, you will always be blamed because of poor time management, lack of ability, incompetence, etc.

    "Okay so I don't want to strike, as a DN any gaps left in patient care will still be there when I come back to work and any deterioration in patient condition will result in more work for me when I get back."

    Unless and until nurses act in a unified manner and that will involve taking effective action, nothing will change. We only need to look at the state of nursing for evidence. In the meantime, our patients will continue to suffer (and that will also get worse) because nurses simply aren't prepared to do anything meaningful. It comes up here a lot, but it is no less true......we should look at our colleagues in Australia who had the courage and the smarts to take on the government and win. Meanwhile, we continue to wheel out excuses for doing nothing. 'My patients will suffer if I am not there to do it' being the prime example. If the government have their way and continue to cut staff posts at the current rate, you may not be there for much longer. Wouldn't it be better to do something about it now, before that happens?

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  • Anonymous | 19-Aug-2013
    5:25 pm

    How about starting campaigning?
    By finding a voice.
    Use the Internet

    Post videos on YouTube about your wards,
    tell the public about what is going on.
    Use Twitter to campaign
    Demonstrate in Hyde Park explaining the lack of resources and make it urgent

    You have support in the country
    Tell the public and they will support you.
    They will help you fight and win.

    The reason the government are continuesly winding you down, getting you burnt out, endlessly pressurising you so you are simply too tired, too exhausted to fight back is you have no voice.

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  • PDave Angel | 20-Aug-2013 8:18 am

    I appreciate your suggestions. I see your posts often here and they are always very supportive of nurses. So thank you.

    I agree that a campaign would be helpful. I sign every petition, I vote in every union ballot, I have joined a few campaigns such as the 1:4, for better staffing levels, and I went out on strike over the pensions issue. Problem is that none of my colleagues are interested in getting involved in anything. I believe that if enough of us did SOMETHING, then there would be change. Don't work through breaks, go home on time and show up the gaps in staffing levels. The belief that if 'I am not here to look after the patient, then the patient will suffer' is common and very misguided. By propping up and perpetuating a failing system, we are actually further damaging patient care and facilitate the worsening of the situation. I also know that those who think that the system will collapse without them are the most shocked when their posts disappear........just like that! It happens all the time.

    Posting videos of a work place on You Tube would result in the nurse being very quickly frog marched in front of the NMC!!

    With regards to the public supporting us, I don't see much evidence of that I'm afraid. But I do agree that if nurses spelled things out in a proper campaign, then they might realise what's really going on.

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  • I am doing my bit as I am writing a play
    about Nurses

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  • It's not surprising that the government isn't doing this, as they have zero interest in creating staffing tools that would force them to employ more nurses, and create an obstacle to the privatisation of the NHS. We should publicise this widely so people are aware of all the unbelievable foot dragging that is going on over this issue by the government.

    Nurses will only obtain safe staffing levels, either through mandatory ratios of evidence based staffing tools when we act. The reason California and and Australia have ratios is because their nursing unions fought for them.

    Unfortunately the caliber of leadership in UNISON and the RCN is lacking and they do little more than talk about the matter. If they were serious about safe staffing they would be organising meetings in every hospital to galvanise support among staff for ratios, and start organising the protests, demonstrations and action we need to pressure this government into implementing them.

    This is the easiest issue to organise around, is popular with the public, is constantly in the media and would protect and increase the number of nursing jobs if implemented. The inaction of our unions on this is appalling. I expect better from them, especially on such an open door issue like this.

    I'm glad the 4:1 campaign is getting around, people who are interested in doing something can visit the website and join the campaign.

    You can sign the petition here:

    We really need people organising locally though. I know its tough as I try in my own workplace to get people involved and don't often succeed, but it's the only way we'll make anything happen. We're producing a pamphlet to popularise and explain the issue of ratios, and a campaign pack for nurses wanting to start their own 4:1 campaign group in their hospital. If you want to get involved contact us at

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  • tinkerbell

    Mark Boothroyd | 21-Aug-2013 12:12 pm

    Well done Mark. Keep at it. I will sign the petition if I haven't already.

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  • Ellen Watters

    well done, and signed..:)

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  • Anonymous | 20-Aug-2013 1:55 pm

    I have signed it

    I have read about bullying, nastiness, terrified of speaking up, being bunt out

    I feel like crying sometimes
    I want to hug all of you and tel you have support and are loved

    Yet Nurses still come in everyday and still manage to look after patients

    How do you manage that?


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