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Trusts face pressure on NICE safe staffing recommendations


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.

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.


Readers' comments (6)

  • What a disgraceful mess.

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  • michael stone

    Does anybody else get the feeling that NICE and the CQC have decided that enough is enough, and that whether or not it suits the Goverment, they are going to take their roles seriously ?

    It does put the Goverment in a tricky position - they can't say 'we don't believe NICE and the CQC'.

    It reminds me of an old one from either Yes Minister or Yes Prime Minister. Jim was discussing setting up a judge-led inquiry into something, and Jim asked Sir H 'How do we make sure the judge decides the way we want ?'. Sir H is horrified: 'It would be quite improper, to try and influence the findings of a judge, minister'. Jim 'So how do we make sure the inquiry goes our way ?'.

    Sir H: 'We appoint a judge, who we know will see the issues the way we do'.

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  • And as most senior judges are either Tories themselves or are related to Tory MPs or Ministers, this government's Jim Hackers should find such appointments pretty easy to arrange!
    I agree with Mr Stone - I think NICE were just not prepared to stand by and see all their hard work ignored/side-lined, just because it is politically inconvenient. So, good for them.

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  • It seems that only recommendations of the Frances report that suit the government are forcibly put into action. And yet the main findings of; management not listening to the frontline staff, and poor staffing numbers are being pushed aside and watered down.
    Recommendations are not enough, the RCN are full of published reports ending in recommendation.
    When I have place these under the noses of my senior nurses, all they say back to me. 'Well of course it is only a recommendation'.

    Meanwhile, we work shifts where there are 12 sick patients to one trained nurse, or now to balance the figures, 24 patients to 3 trained nurses,but have lowered the numbers of HCA's accordingly.
    So at the beginning of a shift, we just decide which trained nurse is to be the health care assistant for most of the time.
    You cannot expect one person to wash and dress 14 dependant patients on their own.
    This is all juggling figures to stop facing up to the reality that you need more nurses per shift.
    Thank you NICE for not giving in to the pressure. The whole reason you were chosen by Lord Frances is because you are independant of the NHS. Well done.

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  • how about one nurse looking after two HDU patients and 7 level 1 patients? very safe indeed!

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  • diabetic patients undergoing amputations because they have not been monitored properly according to BBC London radio this morning.

    this is one example and is not the type of nursing I learned or wish to be associated with and am glad I am no longer part of it but unfortunately eventually the majority of us end up in their hands and risk suffering a similar fate!

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