NHS employers may have to increase the numbers of nurses in accident and emergency departments, after regulators and the Department of Health suggested trusts needed to consider new safe staffing evidence from the National Institute for Health and Care Excellence.
It emerged on Friday that NICE is planning to make public its completed work on A&E safe staffing – despite being asked to suspend the programme by NHS England last month.
- NICE to publish A&E staffing guidance halted by NHS England
- NICE advisor calls on A&E nurses to publish own staffing data
Now the Care Quality Commission has told Nursing Times’ sister title Health Service Journal that it will look closely at the work by NICE and consider how to incorporate it into its independent inspection regime.
The regulators Monitor and the NHS Trust Development Authority both said they expected NHS trusts to use all available evidence when deciding on staffing levels, while the Department of Health said trusts should consider the NICE recommendations as NHS England continues to develop its own approach.
Although the publication of the A&E recommendations by NICE, due at the end of this month, will not be official guidance, it will be the best assessment of staffing levels and impact on patient outcomes in A&E that has yet been made available to the NHS.
Pressure to act on the findings may exacerbate the current national shortage of nursing in the UK following the Francis report, which according to Health Education England saw in-year demand for nurses increase by 23,000 – more than all the output of every nursing school in England.
A draft of the A&E NICE guidance published in January for consultation recommended a series of minimum nurse to patient ratios in emergency departments across a number of different situations.
NHS England asked NICE to suspend its work on safe nurse staffing last month, sparking criticism from Sir Robert Francis, Dr Bill Kirkup and a range of nursing unions and workforce experts.
However, NHS England argued that t would be best placed to take forward the work as part of ongoing service reviews into emergency care and mental health, which would consider other staff groups such as allied health professionals.
A spokesman for the CQC said: “We will look carefully at the guidance coming from either NICE or NHS England. We will then decide how best to incorporate this into our inspection methodology.”
As an independent regulator of standards, he said CQC inspectors would assess staffing levels during all inspections by observing care, talking to patients, examining staff numbers, incident reports and other data. He added: “Our judgements about staffing are never based solely on numbers.”
A spokesman for the TDA said: “We expect all trust boards to look at the evidence available when making decisions about staffing levels across the full range of services they provide.
“Any new work in this area will add to the range of information and tools already available to support trusts in making their judgements,” he added.
“NICE guidance will continue to be used by NHS trusts to help them look at their approach to staffing”
Department of Health
Foundation trust regulator Monitor, which could soon be handed new responsibilities for quality improvement and patient safety, also said: “We would expect foundation trusts to use all available evidence, including local data and nationally produced guidelines, to ensure they are providing safe staffing levels and the best care for patients in all departments, including A&E.”
The Department of Health initially referred questions on how trusts should respond to the NICE publication to NHS England, but when pressed said it expected them to consider what was published.
A DH spokeswoman said: “We remain committed to supporting NHS trusts to use their resources as effectively as possible for patients, including the critical priority that staffing levels are safe.
“NICE guidance will continue to be used by NHS trusts to help them look at their approach to staffing and decide what is best for patients,” she said. “NHS England will take this work forward.”
HSJ asked NHS England to respond on Friday but it had not done so before publication.