A respected team of nurse researchers are to play a key role in drawing up future guidance on safe ward staffing levels, but the final decision on what to recommend will be overseen by a health service manager.
Nursing Times understands that the nursing academics who led research that found patients were at risk if registered nurse to patient ratios fell below one to eight have been commissioned to conduct a government backed review of the evidence on safe nurse staffing levels.
However, the advisory committee that will make final recommendations on nurse staffing on acute adult inpatient wards will be chaired by a hospital chief executive.
As part of the government’s response to the Francis report into care failings at Mid Staffordshire Foundation Trust, health secretary Jeremy Hunt asked the National Institute of Health and Care Excellence to develop guidance on safe staffing.
Following an open tender, NICE has awarded the contract to conduct a literature review to the University of Southampton.
The team will be led by Professor Peter Griffiths, the university’s chair of health services research. Professor Jane Ball, deputy director of the National Nursing Research Unit at King’s College London, will also contribute to the review.
They worked together on the seminal RN4CAST study, which found hospitals with an average ratio worse than 1:8 would expect to see around 2% more deaths per year among surgical patients and 1% for medical patients, compared to the best staffed 20% of hospitals.
Their research has been championed by the Safe Staffing Alliance – a coalition of nursing organisations and unions formed almost a year ago – that is calling for a national minimum staffing ratio of 1:8.
A spokeswoman for NICE said the researchers had been commissioned to conduct “objective reviews of the literature” but “not to make recommendations on staffing levels”.
She said the recommendations for staffing on acute adult inpatient wards would come from a new body, to be called the staffing levels advisory committee. It would consider the evidence “alongside relevant economic models”, she said.
The advisory committee is to be chaired by Miles Scott, chief executive of St George’s Healthcare Trust in London.
It will also include two directors of nursing, three other senior nurses, a healthcare assistant representative, a health economist and three external workforce experts as well as representatives from other health professions. The full membership will be announced next year.
A spokeswoman for NICE said Mr Scott had been chosen to chair the group as an “excellent chair with the skills to lead an independent committee through the complex areas of research related to staffing”.
Speaking during an NHS England webinar on the topic, Mr Scott said major challenges to delivering safe staffing levels included patients with special needs, varying dependency and poor operational processes.
“You can have a fantastic ward manager, you can have brilliant staffing levels but if the operational processes – [such as] the way in which meals are bought into the wards, the timing of ward rounds – are poor, staff and leadership have to compensate for that,” he said.
He said his group would also have to consider the “challenge of productivity” but posed the question of whether staffing would become a “no go area” for efficiency savings.
He added: “We need to understand both how we deliver our productivity requirements and also our quality and safety requirements.”
Guidance on staffing levels for acute adult inpatient setting is the first of 10 topics to be produced by NICE. Subsequent areas include accident and emergency, mental health inpatient and community settings and operating theatres.
A steering group is being set up to prioritise the topics that are looked at, although recent NICE board papers suggest areas where an evidence base already exists will be first to get guidance.
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