A new overarching regulator will work with the chief nursing officer on safe staffing guidance, with their recommendations vetted by the National Institute for Health and Care Excellence, Jeremy Hunt has announced.
In a major speech on the future of the NHS, the health secretary said this morning that there could be “no compromise” on safe staffing.
His comments come in the wake of the controversial decision by NHS England to halt NICE’s own programme of safe staffing guidance, which was recommended by the Francis report, and produce its own instead under the stewardship of CNO for England Jane Cummings.
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Mr Hunt announced two measures today seemingly designed to provide reassurance in the wake of the surprise move by NHS England last month, which has resulted in ongoing criticism from nurses and other patient safety stakeholders.
The health secretary said that the national director for patient safety, Dr Mike Durkin, and his team would move from NHS England to a newly-created regulatory body, where they would work with the CNO on future safe staffing guidance.
“We need a methodology that properly assesses and publishes what appropriate levels of staffing should be”
The new regulator, to be called NHS Improvement, will replace the two existing regulatory bodies Monitor and the NHS Trust Development Authority.
In addition, Mr Hunt said the guidance drawn up by Dr Durkin and the CNO would be independently vetted by a trio of NICE, the Care Quality Commission’s chief hospital inspector Sir Mike Richards and Sir Robert Francis – author of the seminal report into care failings at the former Mid Staffordshire Foundation Trust.
Sir Robert himself has already criticised the move to halt the NICE safe staffing programme, which his report had recommended.
Speaking today at the King’s Fund, Mr Hunt said “safety and quality will be at the heart” of NHS Improvement’s remit.
He said Dr Durkin’s would move there with “two early priorities”, one of which would be to work with the CNO to “complete the work started by NICE on safe staffing levels”.
He stated: “There can be no compromise on the issue of safe staffing and we need a methodology that properly assesses and publishes what appropriate levels of staffing should be, taking full account of the changes that can be made with new technology and modern multidisciplinary work practices.
“This will be independently reviewed by NICE, the chief inspector of hospitals, and Sir Robert Francis to ensure it meets the high standards of care the NHS aspires to,” he said.
Mr Hunt said the second priority for Dr Durkin would be to set up a new Independent Patient Safety Investigation Service.
The body would be modelled on the Air Accident Investigation Branch used by the airline industry, he said, repeating a comparison with flight safety made in earlier speeches.
“A ‘no blame’ learning culture in that industry has led to dramatic reductions in both fatalities and cost – and we now need to do the same in healthcare,” said Mr Hunt.
“We won’t be able to afford the staff we need if we simply say we are going to solve this problem by recruiting more and more staff”
But, in a question and answer session following his speech, he suggested he did not support the approach that had increasingly been taken by the NICE towards recommending safe nurse-to-patient ratios in certain settings, such as accident and emergency departments.
Professor Anne Marie Rafferty, dean of the Florence Nightingale School of Nursing and Midwifery at King’s College London asked the health secretary why the work by NICE was stopped.
In response, Mr Hunt said: “I am the secretary of state who made sorting out the safe staffing my number one priority in my response to the Francis report.”
He said he “never wanted” mandatory minimum staffing levels for a “very simple reason”.
This, he said, was that you could have two trusts – one with higher levels of staff who spent “a lot of time filling out forms” and another with lower numbers but with “vastly safer care because they worked out systems and process which means staff can spend 80% of their time on patient contact”.
“We won’t be able to afford the staff we need if we simply say we are going to solve this problem by recruiting more and more staff,” said the health secretary.
“When it comes to safe staffing, there can be no compromise and its reassuring that there is a role for NICE, the CQC and Sir Robert Francis”
He added: “We need to have a smart model that looks at the benefits of technology and issues like patient contact time, and the safety of care, and then works out a metric taking all those together as to what is the safe and appropriate number of staff to have – which is what Mike Durkin’s work will do.”
The Royal College of Nursing welcomed Mr Hunt’s comments on not compromising on safe staffing and said it was “reassuring” a role would be played by NICE, the CQC and Sir Robert Francis.
However, it warned that there was “still a lot of detail missing”, for instance, on the exact nature of NICE’s role in the process, where responsibility would lie and how it would be resourced.
Howard Catton, head of policy and international affairs at the Royal College of Nursing, also called for other CQC experts, as well as the chief hospital inspector, to be involved in the staffing guidance review process outlined by the health secretary.
He name-checked Andrea Sutcliffe, chief inspector of adult social care, and Professor Steve Field, chief inspector of general practice, as examples.
“If not, it could exacerbate acute bias and send a signal about priorities,” he told Nursing Times.
Jeremy Hunt speech: what else did he announce?
- More transparency
Jeremy Hunt set out his 25 year vision for the NHS in a wide ranging speech, promising the NHS “more transparency in return for fewer targets”.
Next March, he said England would become the first country in the world to publish avoidable deaths by hospital trust and – with the help of the King’s Fund – publish ratings on the overall quality of care provided to different patient groups in every local health economy.
- Seven-day services
Mr Hunt issued an ultimatum to the British Medical Association to negotiate over changes to hospital working hours in order to improve care standards and reduce mortality rates at weekends and in the evenings.
By the end of the parliament, he said he expected the “majority of hospital doctors to be on seven-day contracts”.
“There will now be six weeks to work with BMA union negotiators before a September decision point. But be in no doubt: if we can’t negotiate, we are ready to impose a new contract,” he said.
- International buddying programme
The health secretary announced an international buddying scheme, involving five trusts and the US firm Virginia Mason in Seattle, which he described as “perhaps the safest hospital in the world”.
The partnership scheme, starting this year, will involve the following trusts – Surrey and Sussex Healthcare, Leeds Teaching Hospitals, University Hospitals Coventry and Warwickshire, Barking Havering and Redbridge, and Shrewsbury and Telford.
“If we want to be the best we must learn from the best - whether Kaiser Permanente in California, the Mayo Clinic, Alzira in Spain, Apollo in India or anyone else – and I look forward to developing further international partnerships over the months ahead,” said Mr hunt.
- Increasing patient power
Mr Hunt pledged that “within the next five years” electronic health records will be available “seamlessly in every care setting”.
In addition, from next year, as part of the new electronic booking service that has replaced Choose and Book, he said all GPs will be asked to tell patients not just which hospitals they can be referred to, but the relevant CQC rating and waiting time as well.
Before the end of this year, NHS England will also come up with “concrete proposals” to ensure there is “meaningful choice and control” over services offered in maternity and end of life care and for those with complex long-term conditions, he said.
- Read the whole of Jeremy Hunt’s speech: ‘Making healthcare more human-centred and not system-centred’