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NHS leaders 'didn't like answer' they got on staffing levels


A senior figure at the National Institute for Health and Care Excellence has suggested NHS leaders scrapped its safe staffing guidance programme because they “didn’t like the answer” they were getting on current workforce levels.

Mark Baker, director of the centre for clinical practice at NICE, was speaking at the Patient Safety Congress in Birmingham yesterday.

His comments come after the controversial decision by NHS England chief executive Simon Stevens last month to suspend NICE’s work on safe nurse staffing levels.

“If you don’t like the answer to the question, you don’t ask the question”

Mark Baker

The work had been a recommendation of the Francis report into failures at Stafford Hospital.

The decision has provoked widespread criticism from unions and nursing workforce experts. NICE guidance on accident and emergency nurse staffing has been completed but is now not expected to be published.

Professor Baker confirmed that NICE would not carry on its work on safe staffing independently of NHS England.

He said: “We’re not going to do that because the body that commissions it said they don’t want it.

“I think the reason they don’t want it is, if you don’t like the answer to the question, you don’t ask the question,” he said.

He added: “In a way the underlying problem is that the NHS has survived for most of its history by taking risks and not getting found out.

“[But] if you eliminate the chance of being found out it, then it becomes an unmanageable system,” he told delegates.

But Professor Baker, a former chief executive of Bradford Teaching Hospitals Foundation Trust, noted that while guidance on specific nursing levels “may well work for general acute wards”, it might not for other sectors.

He suggested Sir Robert Francis had been wrong to limit the scope of his recommendation for guidance to qualified nurses.

He said: “So we were asked the wrong question in the first place. Robert Francis probably made the wrong recommendation, certainly about restricting the staffing to nursing.”

He added that, having been told to stop, NICE was “quite relieved not to have to produce guidance which had no traction within NICE and probably shouldn’t have any in the NHS”.

Professor Baker added: “There are guidance issues about staffing which do need to be addressed, but they are clearly not going to be in the immediate future.”

NHS England has said it will continue work on developing safe staffing levels in the NHS and will continue to commission evidence and produce advice for providers, but that work needed to include other roles alongside nurses.


A NICE spokeswoman, in a statement after the session, said: “Our clinical practice director… was asked if NICE would be continuing its work on safe staffing. He told the audience that NICE will no longer develop guidelines in this area.

“However, making sure that hospitals and community services are safely staffed remains an important priority for the NHS. The guidance that NICE has already published on safe staffing levels in adult acute wards and in maternity settings was widely welcomed and will continue to be used.

“NHS England now has to decide how best to review the approach to setting safe staffing levels and whether or not to take forward the work that NICE has already done for accident end emergency departments and mental health and community settings.

“This review will form part of its wider programme of work to help the NHS deal with the challenges it is facing over the next few years. It is no easy task to develop guidelines on the safe staffing of hospital wards and other healthcare services due to a lack of evidence in this area, but we stand ready to support NHS England’s work using the experience we have gained over the last two years.”


Readers' comments (8)

  • michael stone

    '“I think the reason they don’t want it is, if you don’t like the answer to the question, you don’t ask the question,” he said.'

    Well - if you probably wouldn't like the likely answer - but otherwise, a lot of us also think that.

    Sir Robert Francis is a very good analyst: if he only suggested that safe staffing levels for qualified nurses needed to be looked into, I strongly suspect that Sir Robert had a good reason. If I had to guess, it would be that establishing a minimum number of RGNs stops hospitals 'trading off nurses for HCAs', and Sir Robert probably also felt that medics are more likely than nurses 'to kick up a huge stink' if there are dangerously low levels of doctors around (I'm not saying the doctors would 'shout loud enough' - just that I think they 'shout louder' than nurses tend to).

    This must be 'galling' (although I'm assuming he wrote 'shouldn't' when I would write 'wouldn't'):

    '... NICE was “quite relieved not to have to produce guidance which had no traction within NICE and probably shouldn’t have any in the NHS”.'

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  • NICE one Stone!

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  • I agree Michael.

    I remember when the Black Report came out in the 80's. Again this report highlighted the number of RN's to patient ratios = improved care and recovery at a faster rate. Here we are in 2015 and the same debate rumbles on.... A senior QC makes excellent recommendations and the NHS 'higher eschelons' feel they know better. If NHS England (and whoever else is involved) and the Trust workforce/HR know better we will have another 'Stafford'.
    The Trust management thought they knew better at Stafford and look what happened!
    The UK is short of good quality trained Registered Nurses. Bring back the style of training I had for 3 years in 1985, ie cheap accomodation and a salary to allow students to train. Then the NHS and patients will benefit. Or carry on as we are and see patient care suffer. But hey workforce/NHS bosses know best, Im only an RN....

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  • michael stone

    Anonymous | 8-Jul-2015 9:04 am

    Just as well you agreed with me anonymously - if you agree with me on NT and you can be identified, you tend to attract 'abuse' !

    I'm entirely with you on this one - the politicians ignore the evidence when it suits them.

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  • Where is the CQC in all this, when it comes to Nursing Homes they are actively involved in staffing levels, I thought that they have a similar role with the Trusts ?? or is it one set of rules for some and another for the NHS

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  • With you both on this one. And do hope that tedious troll would shut it.

    Re use of qualified nurses check out the Buurtzorg model practised in the Netherlands. It Has been audited. It has the lowest costs and the highest patient satisfaction. Savings translated to the UK are rated as £6 billion per year. However mismanaging bosses would lose their sycophantic colleagues.

    Yep, what's not to like.

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  • michael stone

    Anonymous | 8-Jul-2015 11:15 am

    Being too lazy to look up 'the Buurtzorg model' (which I've noticed being mentioned on NT before, presumably by you ?) and as my online time is usually occupied with things more relevant to me, I stumbled across a piece on BBC Radio 4 a couple of weeks ago, when some nurses who work in the Buurtzorg system were describing how they work, and it was being compared to how our community nurses work.

    The piece was effectively an advert for the Buurzorg system, which looked extremely successful and also seemed to make sense to anybody who isn't, to use my phrase, 'deeply attached to systems and auditing'.

    Now that I have some grasp of what the Buurzorg system amounts to (so far as I understand it, it lets nurses organise their own working day to fit the needs of their patients, rather than nurses being 'tasked by management') I think it makes great sense: and both the nurses and the patients who were in the programme, seemed very happy with it.

    I notice you did mention what some in 'the NHS/system' might find a drawback in your piece above:

    'However mismanaging bosses would lose their sycophantic colleagues'

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  • Get rid of university training and go back to how it used to be in the 70's a proper apprenticeship with a wage and a roof over my head.

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