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NICE to publish A&E staffing guidance halted by NHS England

  • 11 Comments

The National Institute for Health and Care Excellence will publish recommended nurse staffing levels for accident and emergency departments, despite being asked by NHS England to drop the work.

Since NHS England’s decision last month, NICE has also continued evidence reviews on safe staffing for four other healthcare settings.

“All of that work will be finished by the end of July and put in the public domain and given to Jane Cummings to be done with as she wishes”

Mark Baker

NICE plans to publish these evidence reviews, alongside its controversial A&E work, at the end of this month, a senior figure from the institute has told Nursing Times’ sister title Health Service Journal.

The publication of its final A&E proposals – even though not be badged as official NHS guidance – could put pressure on NHS England and ministers to adopt the measures or explain why not.

The news comes little more than a month after NHS England asked NICE to stop its work developing safe staffing guidance. NHS England intends to carry on the work itself through ongoing reviews of services including mental health and urgent and emergency care.

NICE’s A&E recommendations are expected to include proposed minimum nurse to patient ratios for a number of different scenarios – an approach NHS England chief nurse Jane Cummings has previously resisted.

A member of the NICE advisory committee on safe staffing last month said the A&E guidelines would expose a number of trusts as being “inadequately staffed”.

Mark Baker, director of the centre for clinical practice at NICE, said the organisation stood down its safe staffing committee following NHS England’s decision.

“With the exception of general acute ward staffing, there isn’t any reliable evidence of the relationship between nursing staff numbers and patient safety”

Mark Baker

However, it used its own staff to continue evidence reviews on safe staffing for four healthcare settings: community and inpatient mental healthcare, learning disability services, and community services.

Professor Baker said: “All of that work will be finished by the end of July and made available in the public domain and given to Jane Cummings to be done with as she wishes.

“It is the only systematic review on this scale that has probably ever been done,” he said. “It will certainly be useful to whoever is looking to set staffing levels, now or in the future.

“Perhaps more importantly, it should lead to definitive research so that in future we can develop evidence based guidance,” said Professor Baker.

He added: “The A&E work has already been sent to Jane Cummings. We sent it to her within a day of the [NHS Confederation conference] where the decision [to suspend the work] was announced. So it has not been consigned to the dustbin at all.

“What we have done is going to be used in one form or another and will be publicly available,” he said.

Asked about which organisation was best placed to evaluate the evidence on safe staffing, Professor Baker said: “I think most people would say that the developer of guidance should be independent of the [commissioner]. But you can understand the [commissioner’s] concern about that when the impact of the guidance may directly affect their costs.

Mark Baker

Mark Baker

“We have no real idea as to why NHS England did what they did. We had been pressing the [Department of Health] and NHS England about where this work was going because if it was going to be of use we had to look at how services were staffed and not just one profession within those services.

“That potentially wider staffing guidance could well have had profound effects on the organisation of healthcare and almost certainly more profound than would be comfortable for either commissioners of services or their political masters.”

He called for more research on staffing levels and its link with patient outcomes and pointed to a lack of overall evidence. He said: “NICE produces guidance which is based on the most reliable evidence.

“With the exception of general acute ward staffing, there isn’t any reliable evidence of the relationship between nursing staff numbers and patient safety,” he said. “Because of that, it is difficult for the guidance to have any real scientific credibility, whoever produces it.

“We were asked the wrong question in restricting it to nursing and, even if it had been broader, I’m not sure the guidance would have deserved any greater credence because it is not a well researched area,” said Professor Baker.

“There should be a commitment to do research into the relationship between staff seniority, numbers and outcomes for patients,” he added.

  • 11 Comments

Readers' comments (11)

  • Well that's the first ray of sunshine in a week where pay would continue to fall in real terms and the poor had their legs kicked out from under them

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  • Well said

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  • ***
    “With the exception of general acute ward staffing, there isn’t any reliable evidence of the relationship between nursing staff numbers and patient safety,” he said. “Because of that, it is difficult for the guidance to have any real scientific credibility, whoever produces it.

    “We were asked the wrong question in restricting it to nursing and, even if it had been broader, I’m not sure the guidance would have deserved any greater credence because it is not a well researched area,” said Professor Baker.
    ***

    Ain't that the truth?! So why don't we all stop waiting for magical guidance from above and treat this (as it should always have been) as an internal matter - each ward, each A&E - ask the doctors and nurses there: what's effective? what's safe? what's sustainable?

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  • michael stone

    Good - NICE was being badly treated in this, and provided any work it has already completed has reached a 'publishable level' then it should be openly published.

    'There isn't any decent evidence' plagues my end-of-life debates - 'nobody is collecting the necessary figures' seems to afflict the NHS.

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  • ?? up bright and early this morning Micahel Stun

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  • michael stone

    The quality of the spelling on this website is not uniformly high, I notice.

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  • MS - don't bite, and lower yourself. ... (and should have read Michael Stun - 'Keep it to yourself' fame). You have apologised for whatever went on in the past and, I for one and many others, value your comments. Let's move on....

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  • michael stone

    Anonymous | 12-Jul-2015 1:40 am

    I apologise, the problem is that some of the 'insults' I get on this website, are so 'internally inconsistent' that I struggle to always restrain myself from pointing the fact out (in all honesty, I should restrain myself - I have this 'you are taking a gun to a knife fight' feeling, and that isn't very honourable !).

    The 'insults' in BMJ rapid responses are more 'subtle' - but you can often still tell when a couple of people 'are having a go at each other' (although they have to publish with their names, on the BMJ).

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  • michael stone | 12-Jul-2015 12:59 pm

    go troll somewhere else!

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  • Really how much research have to be done.
    We need an intelligent program to be drawn up which involves patients' Activities of Daily Living, what help is required for how long, how often & by whom, also patients' High dependency NURSING needs.
    Timing,medication, procedures,dependency,
    tasks and professional needs are all important elements for the program.
    Obviously a program will have to be drawn up for all the different areas that require a real need for safe staffing levels. It could be long winded, but it is not difficult to do.
    With the right strategy and intelligence it is the best way forward.

    Safe staffing is VERY IMPORTANT, it means patients can receive what they need and staff can be able to do their job effectively.
    Compassion means very little if there is not the right staff to do the job.

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