Ensuring safe nursing staff levels on adult hospital wards will cost the NHS up to £414m, according to an official estimate by the National Institute for Health and Care Excellence. But some leading nurses say the true cost will be at least double that.
The impact assessment estimated the cost of implementing the NICE staffing guidance for adult acute wards, which was published earlier this month, could be anything from £0 to £414m.
The guidance said less than two registered nurses on a ward at any time was a patient safety “red flag” that required action, and acknowledged a ratio of more than eight patients to one registered nurse could increase the risk of a red flag occurring.
Last week NICE followed up the guidance by publishing a separate analysis on its predicted financial impact. NICE said a realistic mid-point when it came to the cost would be around £207m – a 5% increase on current planned staffing levels.
However, it said the extra costs of safe staffing were likely to be offset by savings from fewer pressure ulcers and healthcare-acquired infections, shorter stays in hospital due to more effective care and reduced risk of being sued because of poor care.
“Implementing the NICE guidance is unlikely to have significant financial impact in many trusts but it is possible that a headline additional cost of 5% could be incurred – building over more than one year – but it could well be less,” said NICE chief executive Professor Gillian Leng.
However, some have warned the calculations may be a serious under-estimate, given the majority of trusts appear to be understaffed – as reported by Nursing Times last week.
“It is an underestimate and probably needs to be at least twice that,” said Susan Osborne, chair of the Safe Staffing Alliance campaign group. “In fact I would say it should be a minimum of 1.25bn to ensure safe staffing now.”
Unison’s head of nursing Gail Adams said it was hard to put a figure on the cost of ensuring safe staffing, but she feared the NICE calculation was “a conservative estimate”.
“To be fair to NICE, it’s quite a difficult piece of work for them to undertake,” she said. “You don’t know whether it’s going to be a band 5 or a band 8 nurse that’s needed to look after a patient, so it is hard to put a figure on it.”