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Exclusive: CNO defends takeover of safe staffing work

  • 15 Comments

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.

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”

Jane Cummings

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”

Jane Cummings

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”

Jane Cummings

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.

  • 15 Comments

Readers' comments (15)

  • Why has Ms Cummings allowed the shortage of nurses to develop in the first place? It happened on her watch. Therefore she is not a fit person to take over responsibility for safe staffing levels.
    The Government spent a lot of money on the Freedom to Speak Up review and is now rejecting the findings.

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  • Well said

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  • michael stone

    “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.”

    NICE should be doing the analytical work on this one, as Sir Robert Francis has pointed out - this move 'smells of politics and obfuscation', to me.

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  • I would hope that we can still hope for guidance that will really raise the bar for nursing care. However this is putting the responsibility for evaluating the level in the hands of those overseeing the commissioning of services.

    To date we have not seen any evidence that the commissioning process improves quality, it certainly increases costs and distributes more contracts to the private sector. To date we have seen several major private contacts being simply walked away from, it is essential that any contract is ENFORCED both on quality and provision and punitive fines for non delivery that bring about the end of any company that fails to deliver on public sector provision. This should include a ban on all directors of those companies from any future public contracts. This would go some way to preventing the merry go round of failure, rebranding, re-contracting and failure again.

    It is clear that a fixed staffing ratio is unlikely to take account on variation in dependency and acuity, however it is also vital that turnover of patients is also included. There are many environments where several patients a day occupy a single bed. Guidance should also cover reduction in the number of handoffs of care where patients are transferred multiple times during an episode of care because of over use of resources.

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  • “The focus has been on [registered nurses] and it should be an opportunity to look at workforce in a different way,” she said". In other words- we will see how many registered nurses we can get rid of and replace with care assistants.
    Can anyone please tell me why an unelected Jane Cummings who we all know is merely a government poodle, speaking and making decisions on behalf of nurses? would any other profession tolerate it?

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  • Jane Cummings- “I wrote about the need for safe staffing in [the national nursing strategy] Compassion in Practice, even before the publication of Francis,”. I must have blinked when she did the above. I have never ever known Jane Cummings to speak out about staffing. All I have heard from her is her "Six C" which apparently were going to sole all our nursing and care problems without any need for additional staffing. What hope is the for nursing with this woman at the helm, we will be sailing for the rocks and all she will be saying is, what rocks?

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  • It's simple: she's going to redefine the words "safe" and "treatment" and prove that we don't actually need more nurses. This is obviously an entirely political move - Hunt realised that the NICE work was going to be way too expensive to implement so he's burying it. This WILL come back to bite him.

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  • NICE haven't once proclaimed a nurse to patient ratio. this is the government playing their cards and they will lose. Us nurses will lose out and so will the patients!

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  • Anonymous | 7-Jun-2015 5:41 pm
    your words are so true.

    If JC practiced the 6'Cs she preaches, she would ensure wards were staffed with decently paid NHS nurses not those from an agency. She would reduce the amount of ridiculous and unnecessary paperwork that takes trained staff away from the bedside who then have to rely on often poorly trained HCA s (not all may I add) to provide direct patient care.

    She would ensure that mandatory training involved regular updates on the EWS system and SEPSIS management.

    She would be open and honest about revalidation and how, given staff shortages, the new system will not work unless nurses spend even more of their own unpaid time ensuring they meet requirements.

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  • Jane Cummings is the Tories go-to-girl to cook the books, shaft the NHS, and confuse the public with imperious phrases which in reality means, NICE was deliverinfg a model of a SAFE service, but the Tories don't want to pay for it.

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