The National Institute for Health and Care Excellence yesterday published four evidence documents on safe nurse staffing levels, which relate to its now cancelled programme of workforce guidance.
The move comes after two NICE non-executive directors decided it was in the public interest for the evidence reviews to be made public – in contrast to a previous decision by NICE chief executive Sir Andrew Dillon.
“The panel considered that the public interest factors were very finely balanced in this case”
It is the culmination of a six-month battle by health journalist Shaun Lintern, who regularly contributes to Nursing Times, to get the evidence documents into the public domain.
The documents (see box below) explain assessments of the evidence for safe staffing in accident and emergency, community nursing and inpatient mental health settings. There is also a review of evidence on management approaches to safe staffing.
Read the safe staffing evidence reviews:
The reviews would have informed work on developing safe staffing guidelines by NICE, including recommendations by its safe staffing committee for the NHS to follow when setting nurse establishments.
However, as reported by Nursing Times, the committee was disbanded in June last year when NHS England and the government asked NICE to suspend its safe staffing work. The move sparked widespread anger and concern within the nursing profession.
At the time of the suspension, NICE had already published guidance on safe nurse staffing levels in adult general wards and maternity units. It had also completed, but not yet published guidance for A&E units and was in the process of collecting evidence for future guidelines on community services and mental health.
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NICE had intended to publish the evidence it had collected for the unpublished guidance in July, but reversed this position after conversations with Kristen McLeod, the health secretary’s principal private secretary.
A subsequent freedom of information request made last year by Nursing Times’ sister title Health Service Journal in order to try and obtain the evidence documents was rejected, along with a request to release the completed A&E guidance itself – which remains unpublished.
At the time, Sir Andrew claimed releasing the evidence reviews would disrupt the “management of the health service” and delay the new regulator NHS Improvement from developing its own safe staffing guidance, which is intended to replace the NICE programme.
But, following an appeal, two NICE non-executives – vice chair Andy McKeon and Professor Finbarr Martin, a consultant at Guy’s and St Thomas’ NHS Foundation Trust – met earlier this month to review the decision.
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In his evidence to the non-executives, Sir Andrew said he remained satisfied that publishing the evidence reviews would be likely to “prejudice the effective conduct of public affairs” and lead to “considerable confusion and uncertainty”, which would “impact adversely on those trying to manage NHS services and take decisions about resourcing”.
In their ruling, the two non-executives noted that the ”public interest factors were very finely balanced in this case”.
But overall they said they had “concluded that the public interest in avoiding the likely prejudice identified by Sir Andrew did not outweigh the public interest in disclosure” and ruled, therfore, that ”the materials should now be disclosed”.
The evidence reviews were carried out by NICE as part of its work to develop safe staffing guidelines for the NHS – a key recommendation of the Francis report into failings at the former Mid Staffordshire NHS Foundation Trust.
The new body NHS Improvement – formed from a merger of Monitor and the NHS Trust Development Authority – is expected to publish new guidance on safe staffing later this year.
However, it is expected to take a multidisciplinary team approach rather than focus on nursing staff and it will not set a minimum nurses to patients ratio.