The chief nursing officer for England has defended her takeover of responsibility for safe staffing guidance from the National Institute of Health and Care Excellence.
Jane Cummings told Nursing Times she had suggested to NHS leaders earlier this month that the NICE programme could be stopped because of overlap with similar work by her own department.
However, she admitted that her team’s work would look at “value for money” and re-emphasised her long-held view that imposing rigid nurse-to-patient ratios were not the answer to safe staffing.
There was surprise and alarm yesterday when it was revealed that NICE was abandoning its programme on safe nurse levels, especially coming in the wake of new measures to cut spending on agency staff.
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The programme’s suspension was revealed in a leaked email from NICE chief executive Sir Andrew Dillon, which was revealed by Nursing Times’ sister title Health Service Journal.
The revelation came after NHS England chief executive Simon Stevens described the NICE work as “too mechanistic” in a speech this week to the NHS Confederation conference in Liverpool.
“I will work on this with the triple aim of improving outcomes, improving experience and ensuring value for money”
Mr Stevens said work on determining safe staffing levels would instead be taken on by the CNO’s office, which is part of NHS England.
Speaking to Nursing Times, CNO Ms Cummings defended the move to halt the independent NICE programme and instead take it within NHS England and incorporate it into other service reviews.
Ms Cummings said that, while she understood people’s concerns, she did not agree with their criticisms.
“I wrote about the need for safe staffing in [the national nursing strategy] Compassion in Practice, even before the publication of Francis,” she said.
“It’s always been important to me, and I’ve always said it’s not just about the numbers,” she said. “It’s not about the costs, but there is no more money and we have to find a way to work efficiently without affecting quality.”
She added: “I will work on this with the triple aim of improving outcomes, improving experience and ensuring value for money.”
She said her programme board had the support and involvement of a range of bodies including the Department of Health, NHS Employers, Health Education England, the Trust Development Authority and Monitor.
“I am working with colleagues from these areas, but I will involve independent advice. What will underpin the work is the triple aim,” she said.
Ms Cummings said the focus of safe staffing must be on hiring permanent staff, ensuring that staff are being used efficiently so making the most of e-rostering and flexible working, workforce planning, developing healthcare assistants’ skills to allow their progression, and multi-professional working.
“[We need to identify] staffing needs and patient outcomes rather than through input numbers or ratios”
She cited a letter that she had sent earlier this month to Mr Stevens and Ian Cumming, chief executive of Health Education England, on the issue.
In it, Ms Cummings reported back on the work of the Nursing Workforce Programme Board, which she established at their request earlier this year.
She said in the letter that she believed the answer to a system that relied on “high cost temporary staff” to deliver “safe, consistent, quality care”, lay in the five key areas of focus that she outlined in her interview with Nursing Times – namely permanent staff, planning, HCAs, multi-professional teams and efficiency.
In the letter, dated 3 June, MS Cummings said that when considering staffing levels we should look beyond the “traditional professional boundaries” and said the Five-Year Forward View provided an opportunity to do that and focus on “holistic assessment of staffing”.
She said there was a need to identify “staffing needs and patient outcomes rather than through input numbers or ratios”.
More crucially, she added: “This means that the programme of work commissioned from NICE could be stopped.”
However, Ms Cummings told Nursing Times she did not intend to make the work done by NICE already “defunct”.
Instead, she said she wanted to ensure the approach to staffing involved the whole clinical workforce.
“The focus has been on [registered nurses] and it should be an opportunity to look at workforce in a different way,” she said.
Ms Cummings acknowledged that a lack of nurses was an issue for many directors of nursing.
She suggested it was a problem that workforce planning and the work being done by Health Education England around the Shape of Caring Review would help with, as would the other four areas of the Nursing Workforce Programme Board.
“The focus has been on [registered nurses] and it should be an opportunity to look at workforce in a different way”
The letter also emphasised the importance of “contact hours”, something mentioned by health secretary Jeremy Hunt in his speech yesterday at the NHS Confederation conference, and known to be an initiative he is vocal about supporting.
Critics have suggested that NHS England lacks the independence and rigour to issue advice on staffing levels, and that its focus will be about cost savings rather than safety.
They have also felt that it is a U-turn from the government’s response to the Francis report, which specifically recommended NICE undertake the safe staffing work.
The CNO added that her office does not, as yet, have any plans to increase resources to manage this work, and that it was yet to work out the detail of how to implement the plans.