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Halting of NICE safe staffing guidance programme sparked nurse safety concerns


The suspension of safe staffing guidance produced by the National Institute for Health and Care Excellence has left almost three quarters of nurses worried that patient safety will suffer, a major UK survey has revealed.

After the work was brought to a halt by NHS England last year, organisations were told guidelines that had already been produced for acute adult inpatient wards and maternity units should be upheld.

“The majority of respondents reported that staffing levels are not sufficient”

Unison report

However, only 17% of survey respondents working on an adult inpatient ward in an acute hospital in England said their organisation continued to use the guidance. Almost two-thirds – 61% – said they did not know whether their employer was continuing to use it or not.

The union Unison, which carried out the snapshot survey of 2,708 nurses on 9 February, said the suspension of the NICE guidance had caused “mass confusion” in acute settings.

The annual survey found 71% of respondents were worried that staffing levels would get worse and patient safety would suffer as a result of the NICE work being stopped.

In addition, staffing ratios recommended in leaked – but never officially published – NICE guidance for accident and emergency departments were not being met in the majority of cases, said the union.

In particular, around 75% of A&E nurses working on 9 February said their shift did not meet the NICE-recommended ratio of at least two registered nurses to one trauma patient. Meanwhile, the same proportion said they did not meet the recommendation of at least one registered nurse to one priority ambulance patient.

Overall, across all ward types, 55% of respondents said they had cared for eight or more patients on the day of the survey – the level at which research suggests harm occurs – increasing to 70% of staff who worked the night shift.


NICE safe staffing guidance halt sparks safety fears

Source: Jennifer Van-Schoor

The situation has worsened since last year’s survey, when around 40% of nurses said they had cared for eight or more patients, including 55% of those on night shifts.

Further analysis of this year’s data revealed the wards where the largest numbers of nurses were reporting a ratio of 1:8 or more were those providing elderly care (80%), medical wards including orthopaedic (75%) and A&E (70%), followed by surgical wards (65%) and mental health inpatients (55%).

Across all of these ward types, the proportion of nurses providing care at this ratio has increased since the same survey last year, with the biggest jump occurring in mental health inpatients (last year 24%) and A&E (last year 40%).

Overall this year, 74% of respondents said they did not have enough time to comfort or talk to patients, and 63% said there were not adequate staff numbers to deliver safe, dignified, compassionate care.

On top of this, almost 40% of nurses taking part in the survey agreed or strongly agreed that staffing levels were worse at their organisation due to fewer agency staff being used, following the introduction of government-enforced rules on agency spending in England.

The rules, brought in at the end of last year, included an annual ceiling for total agency nurse spend for each NHS trust, plus limits on the hourly rates they could pay to agency workers.

Gail Adams

Gail Adams

Gail Adams, Unison head of nursing

Meanwhile, 68% of respondents this year said that they had considered leaving their role in the last six months, up from 50% in 2015.

“The survey results show a continued systemic problem with understaffing which exists nationwide, meaning that patient care is suffering across the country,” said a report on the survey findings – titled Pushing the call button on unsafe staffing: who will come to our aid?

“The majority of respondents reported that staffing levels are not sufficient to deliver the minimum standard of patient care required. This is not surprising when over half are caring for eight or more patients at a time – the ratio at which harm is known to occur,” it stated.

The report also noted that while more than a third of respondents felt their shift had the right skill mix balance, thy were understaffed numerically.

“Many supplemented this with the explanation that healthcare assistants are being told to take on nurse responsibilities,” said the report, which was due to be launched on Monday at the Unison health conference in Brighton.

Consistent with previous surveys, the majority of respondents this year – 89% – said they agreed with the introduction of mandatory minimum nurse-to-patient ratios.

However, the report noted that Wales was the only country in the UK to introduce specific legislation on nurse staffing levels. The Nurse Staffing Levels (Wales) bill, which was passed earlier this year, will initially apply to adult acute wards.

Unison’s survey revealed 87% of respondents agreed it should be extended to apply to other clinical settings.

“While the NHS in England seem to be backing away from the issue, Wales will be the first country in Europe to establish specific legislation,” it said.

“We are still waiting for the detailed implementation guidance which will cover this legislation, but it will be ground breaking in its approach and demonstrates the clear difference in thinking between Westminster and the Welsh Assembly,” said the report.

Key findings from Unison annual survey:

  • 89% support national mandatory minimum nurse-to-patient ratios
  • 63% felt there were not adequate staff numbers to deliver safe and dignified care
  • 61% were unable to take all or some of their breaks that day
  • 70% reported not having an adequate amount of time with each patient
  • 75% said a lack of time meant they were unable to comfort or talk to patients
  • 55% were looking after more than eight patients
  • 71% felt that the decision to suspend NICE’s work on safe staffing would see staffing levels worsen and patient safety suffer
  • 39% said that the introduction of the cap on agency spending had affected staffing levels
  • 68% had considered leaving the NHS in the last year
  • 41% worked over their contracted hours, with 75% putting in up to an hour of extra time, with only 10% being paid for this

Readers' comments (17)

  • michael stone

    I think the nurses are right to be worried - staffing levels, is an area where 'political interference' can play a major part.

    Politicians and 'evidence-based decision-making' do not necessarily fit within the same sentence.

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  • With the dumbing down of the HSE, the inappropriateness of the Union Bill, attack on NHS H & S reps and pursuance of dangerous lean methodology we must strike in line with doctors to protect patients. The RCN is management heavy and morally weak, and so our only hope lies in Unison and Unite. What does it take to wake the unions up? PLEASE UNITE AND UNISON GIVE US THE VOTE TO STRIKE.

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  • Without the opportunity to strike the RCN are colluding against patient and staff safety.

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  • Janet Davies step down you're too weak and have no militancy about you. The time of being agreeable to disagreeable employers is coming to the end STEP DOWN. We know nurses are likely leaving the RCN in droves.

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  • What about realistic negotiation. Can nurses only think strike, strike, strike. How do you think the users about the NHS feel when they can't trust the people who are supposed to care for them go on strike? What message are these nurses sending? Without the patient nurses do not exist - fact. There was care before the NHS and its not that long ago in real terms Sort out the RCN and what its supposed to do.
    And as for NHS staffing ratios 1:8 is really very good on a general type ward including care of the elderly. Try 1:50 in a nursing home with very vulnerable people with multiple co-morbidities. Who's batting for them?

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  • How dare you, with the way things have gone there will be no nurses and patients Will then truly suffer. Striking is the only way forward and it is the right moral way forward. It is bad corrosive endemic management and government making patients suffer and this will be the case if strike occurs. Get your head out the sand negotiation doesn't work and hasn't worked for the last 30 years. This is crunch time show some respect to good nurses and then get out of the way if you obviously can't see the truth. The only thing management and government understand is brute group force. The only way patients will survive is when nurses fight for them.

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  • This is a nurse forum, whilst you have your views, let nurses have a right to their - it's their views now being trampled on by aggressive families and patients used by management to sell their message. Your issue lies with management and government. so get on board with nurses not the bad management and government. I for one am tired of being stifled by aggressive patients, families, government and management. Viva the revolution STRIKE.

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  • I suggest if your working 1:50 your'e already working unsafe and should have reported it to safeguarding, the management to the police, the HSE and CQC. These nurses are sending a message of strength who won't be bullied by Jackie Smith's lawyer led highly subjective NMC, the weak pussy footing RCN and corrupt corrosive personal pension protectingvNHS Management. I and others believe 'The game is almost up for the health establishment'.

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  • This is the way the government is demolishing the NHS. They won't stop until they have brought it to it's knees.

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