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Safe nurse staffing levels could cost £414m, says NICE

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.

Gillian Leng

“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.”

Gail Adams

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.”

Readers' comments (11)

  • michael stone

    The 'more nurses equals less hospital-induced patient problems' one is a bit tricky to cost - much trickier, than just totalling the cost of extra nursing hours.

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  • £0 to £414 millions?

    I'm not sure the data is all in one place to make ANY reliable estimate but "a 5% increase on current planned staffing levels" sounds hopelessly optimistic to me.

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  • Has the NHS been allowed to reduce the number of qualified staff to this level?

    If this is correct then the people who are managing the Service on their high salaries need to be brought to account as this explains all the errors that are occurring and the litigation that comes from it.

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  • michael stone

    roger kline | 28-Jul-2014 2:16 pm

    'I'm not sure the data is all in one place to make ANY reliable estimate'

    Call me a cynic, Roger, but I tend to think that is true for an awful lot of 'NHS stuff' !

    It is definitely true for this one.

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  • Don't you know that becoming an NHS manager, complete with grey suit, comes with Teflon coating.
    I undertake a lot of clinical negligence work and it is NEVER the manager or the budget holder who is blamed, just the poor junior nurse at the sharp end who is unable to provide the care that patient needs at that time because he/she is also caring for a ward full of others with care needs.
    Prioritisation and mitigation is not part of the legal process and it is taking the NHS billions to work it out.
    The only chance we have is for the NHS "suits" to work out nurses are cheaper that litigation- the US worked this out decades ago!

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  • Less than two is one. One trained for a whole ward? Definitely that's red flag. And the probelm is not just the trained, what about the untrained nurses. How do you expect trained to do a perfect drug round if we are the only one who are looking after a bay or bay and a half and everyone is asking you for thinks?
    This systems has a big problem and if you don't solve it this is going to be worst.

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  • This offers no thought to whether community has the infer structure to manage patients following early discharge, I think they will struggle.

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  • it is a real struggle in the community already, there is no plan to increase the number of nurses in the community

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  • In the United States 49 out of 50 states have unlimited nurse-to-patient ratios. This means hospitals have no limitations on the number of patients given to a staff floor nurse at any time. Hospitals are businesses--and like all capitalist endeavors the goal is profit. Hence, all US hospitals are primarily motivated to make money first---patient safety is ALWAYS second. Safe nurse staffing is of concern only to registered nurses who value what they do and how they are able to perform. Hospitals in the US ALWAYS claim the reason for over-burdening nurses with outrageous patient loads (med/surg: 1 to 12, 21; ER: 1 to 7-8, ICU: 1 to 3-4....all unsafe ratios) is 'the nursing shortage'---which is totally false. There is no nursing shortage in the US---there are plenty of nurses available. But hospitals refuse to staff adequately according to patient acuity, patient needs and purposely under-staff nurses to enhance hospital profits. The only shortage of nurses is hospital refusal to hire necessary nursing personnel to meet patient needs. The one and only state in the US that prohibits unsafe nurse staffing procedures is California. And this mandate took many years to legally force implementation. As long as hospitals, LTCs, and clinics place profit before patient safety unsafe nurse staffing will continue and with it more medical errors, more patient injury, more dissatisfied patient reports, increased nurse burn-out and compassion fatigue---and worst of all increased patient deaths. And just how much money does one unnecessary patient death really cost the hospital? Usually, very little--as the nurse assigned is the first to be charged responsibility regardless of how many patients he/she was assigned. Remember: hospitals and LTC facilities are in the business of addressing sick people--not cured or healthy ones. Returning patients to acute wards mean additional monies, additional profits. So, basically these businesses are less concerned about nurses who are motivated to heal than staffing nurses who are only motivated by similar corporate thinking: Money.

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  • If I were a patient about to be admitted to hospital I would definitely be terrified knowing that the staffing levels on my ward are more than likely to be at an 'unsafe' level. !!

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  • To be honest I am so glad I am finishing soon as I am struggling with the ever increasing work load. It is the light after a very long dark tunnel. I walk off the ward absolutely shattered. It is so bad I am dreaming about work every night. I could easily cope and enjoy if we had extra nurses as per NICE guidelines but I can imagine that if a ward is lucky enough to have an extra trained nurse on they will be moved to cover sickness else where.

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