Plans to publish safe nurse staffing guidance for accident and emergency departments have been abandoned in a U-turn by the National Institute for Health and Care Excellence.
The development is the latest twist in the ongoing saga over the future of safe staffing guidance for the NHS in England.
There was surprise and concern last month when it emerged that NICE had been told to stop its programme of work on nurse staffing guidance. NHS England, working with a new regulatory body called NHS Improvement, will be taking over future work on safe staffing guidelines.
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To date, NICE has published final guidance on safe nurse staffing levels for adult acute wards and maternity units, as well as draft guidance for A&E and preliminary research on mental health and community settings.
NICE had previously said it would publish the finalised version of its A&E guidance this month, along with four evidence reviews of safe staffing in other settings, including mental health and community nursing.
However, it has now said it will not make the information available to avoid pre-empting future work on safe staffing by NHS Improvement, the creation of which was announced earlier this month by health secretary Jeremy Hunt.
NICE is understood to have come under “pressure” from both NHS England and the Department of Health not to publish the information on its website, because of fears it would become de facto official guidance that NHS trusts would feel under pressure to follow.
“[NHS England and the DH] are trying to stop it coming out in that form. They wanted to control the information,” a source told Nursing Times’ sister title Health Service Journal.
However, in a statement the Department of Health said the claim was “nonsense”.
It added: “Existing draft work on safe staffing will be published by NHS Improvement as part of a package of supporting evidence for new guidance. What’s more, NICE will be involved in the final approval process for future safe staffing guidance.”
NICE was understood to be planning to make the A&E work available to any member of the public who requested it from today.
This changed last night when it was revealed that the information would remain unpublished and unavailable until NHS Improvement released it later this year.
Eddie Jones, head of the clinical negligence department at JMW Solicitors, said the decision by NICE not to issue its safe staffing guidelines was now “a matter of concern”.
He said: “Having previously made clear its intention to publish this information, it would appear to have come under pressure not to do so… My concern is whether this is an indication of how NICE is to be treated by this government.”
“Clearly it was ready to go and NICE was ready to publish and I think they should publish”
Dr Sarah Wollaston, chair of the Commons’ health committee, said she would be concerned if NICE had been put under pressure.
“I think there is an over-controlling sentiment sometimes with work that has been commissioned with public money,” she said. “Clearly it was ready to go and NICE was ready to publish and I think they should publish.
“It is very important that where bodies are supposed to be independent they are allowed to behave in an independent manner,” said Dr Wollaston, who is Conservative MP for Totnes in Devon.
Dr Clifford Mann, president of the Royal College of Emergency Medicine, said not publishing the information this month was a “retrograde step”, which would “allow unacceptable variation in staff to patient ratios to continue and will inevitably have consequences for patient care”.
“It is difficult to justify why a process that is as methodologically sound as the NICE process can’t be shared with the wider public,” he said.
There has been widespread criticism of the government and NHS England after the latter directed NICE to suspend its work on safe staffing – a key recommendation of the Francis report.
“It is difficult to justify why a process that is as methodologically sound as the NICE process can’t be shared with the wider public”
Earlier this month, Mr Hunt intervened in the row and said work on safe staffing levels would be taken forward by NHS Improvement, with NICE being one of the organisations expected to review the resulting proposals.
Speaking on the decision not to publish the original guidance, NICE chief executive Sir Andrew Dillon said it was important that the institute did not “pre-empt the outcome of the work to be done by NHS Improvement and NHS England by publishing our conclusions at this stage”.
“We do understand and welcome the public interest in our review of the evidence on safe staffing,” he said.
“With this in mind, the DH have confirmed that NHS Improvement will publish our final recommendations later this year, as part of the evidence base for the safe staffing guidelines they are developing.”
He added: “NICE stands ready to support this work using the experience we have gained over the last two years.”