New guidance on setting safe staffing levels, especially for nursing, across five settings has been published by NHS Improvement for use in the health service in England.
It represents the latest chapter in the development of national safe staffing guidance since it was first called for by Sir Robert Francis in his seminal report in 2010 but then controversially halted.
“It is vital that we make sure NHS services are underpinned by safe and sustainable staffing”
The latest safe staffing guidance covers adult inpatient wards in acute hospitals, district nursing services, mental health services, learning disability, and maternity.
It said trusts should take a “clinically-led and evidence-based approach” to safe staffing and that it expected the guidance to help boards to think about it in a “multi-professional workforce manner”.
NHS Improvement described it as a “suite of setting specific, safe, sustainable and productive staffing improvement resources”.
Each one includes example dashboard templates, escalation processes, strategic staffing review guidance and signposting to other resources relevant for their specific health setting.
“In particular, annual strategic staffing reviews should be developed using a triangulated approach”
The resources also provide recommendations to NHS provider organisations on board accountability, and outlines expectations of clinical leaders at service and team levels.
The regulator also said undertaking annual strategic staffing reviews, making decisions based on evidence, peer comparison and professional judgement of patient need were “vital to enable effective safer staffing activity regardless of the health setting”.
In particular, it stated that the strategic reviews should be developed using a “triangulated” approach involving evidence-based tools, professional judgement and comparison with peers.
Such reviews should also take account of all healthcare professional groups and were in line with a trust’s financial plans, said NHS Improvement.
The five documents published today were recently approved by NHS England’s National Quality Board, following a period of consultation on previously published draft versions of the guidance, as reported by Nursing Times.
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The regulator said this consultation and evaluation process was supported by a steering group comprising of senior nurses, leading workforce academics and union representatives.
Meanwhile, further guidance covering children and young people, neonatal, and urgent and emergency care has been published in draft form. An engagement period recently closed on the drafts and feedback is being reviewed prior to final approval, said NHS Improvement.
Dr Ruth May, executive director of nursing for NHS Improvement, said: “It is vital for the continued success of the health system that we make sure NHS services are underpinned by safe and sustainable staffing.
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“Our safer staffing improvement resources are based on the National Quality Board’s expectations that to ensure safe, effective, caring, responsive and well-led care on a sustainable basis, trusts will employ the right staff with the right skills in the right place and at the right time,” she said.
“We have worked with clinicians, leading academic, and stakeholders to create these resources, in the expectation that they will support NHS leaders and their staff deliver compassionate, effective, safe, sustainable high-quality patient care,” she added.
However, as previously reported by Nursing Times, earlier work on staffing guidance by the National Institute for Health and Care Excellence was halted by NHS leaders in 2015, sparking widespread criticism and concern among the nursing profession.
The programme was subsequently handed to NHS Improvement, drawing further criticism that the guidance would be a watered-down version of that already published or planned by NICE.
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The Francis report into the care failings at Mid Staffordshire NHS Foundation Trust had recommended that NICE draw up safe nurse staffing guidance for different settings.
The institute had only published final guidance on acute inpatient and maternity settings, and a draft version on accident and emergency, before the programme was unexpectedly taken away. Its unpublished work was eventually released but never formally recognised by the health service.
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The move followed displeasure at the Department of Health and NHS England over NICE’s recommending of specific nurse to patient ratios that should act as safety red flags.
As a result, the new sets of guidance drawn up under the oversight of NHS Improvement are less specific in terms of set ratios and, instead, promote the use of tools to calculate levels locally.
The new guidance also focuses on a multi-disciplinary approach, with a wider range of staffing groups included as well as just nurses.
New setting specific safe staffing improvement resources published by NHS Improvement
- Safe staffing for adult inpatients in acute care
- Safe, sustainable and productive staffing in district nursing services
- Safe staffing in learning disability services
- Safe staffing for mental health services
- Safe, sustainable and productive staffing for maternity services
Safe staffing improvement resources currently in draft form and open to consultation