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National regulator developing new safety checks for trust workforce plans

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Two nursing directors have been asked by the regulator NHS Improvement to lead work on developing new safeguards to protect care quality when trusts make significant changes to their workforce.

Helen Blanchard, director of nursing at Royal United Hospitals Bath NHS Foundation Trust, and Suzanne Banks, director of nursing at Sherwood Forest NHS Foundation Trust, have been asked to lead work developing safeguards and new tools for providers.

“The winter weather may have left us, but the pressures remain”

Ruth May

This work will be completed by the summer, said a letter from the regulator, which was sent to trusts last week (see PDF attached below).

The letter, signed by NHS Improvement’s executive chief nurse, Dr Ruth May, sets out the body’s expectations on how health service providers should safely pursue workforce reforms, including implementing safe staffing guidance.

The letter from Dr May, who is also deputy chief nursing officer for England, was addressed to nursing directors, medical directors and human resources directors and follows a similar promise earlier this year to challenge weak NHS workforce proposals in sustainability and transformation plans (STPs).

In the letter to trust nursing directors, Dr May said: “We recognise that as senior leaders the issues of supply, retention, planning, agency/locum controls and operational day-to-day staffing issues are ones that you are all focused on.

“This letter outlines the areas where collaborative programmes are in place to support you with the above challenges and also highlights next steps,” she said.

“It is important we focus on the solutions and support the system can provide”

Ruth May

She added: “The winter weather may have left us, but the pressures remain. The workforce challenges are ones that we recognise are daily challenges but it is important we focus on the solutions and support the system can provide through peer best practice and guidance to ensure good outcomes.”

The move follows comments made recently by NHS Improvement chief executive Jim Mackey in which he said the regulator should be “kicking the tyres” on workforce reform to ensure safety.

NHS Improvement would intervene where trusts were making questionable reforms, said Mr Mackey in an interview with Health Service Journal in December.

“I want some basic assurance and I want to see evidence that what they are planning to do at the end of it is better than what they are doing now,” he said.

The letter from Dr May does not describe specific safeguards, but it is expected that the regulator will be looking to ensure a governance process is in place locally and nationally.

This would see trusts needing to demonstrate they had carried out proper risk assessments and had safeguards in place to protect care quality. For example, NHS Improvement will want to be assured there is no inappropriate substitution of some roles.

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Ruth May

This could include a focus on use of the new nursing associate role and the potential substitution of registered nurses as well as physician assistants and advanced nurse practitioners.

A final set of tools will be developed by the summer, with a workshop next week looking at regulation and support approaches, delivering solutions safely, and operational and quality outcomes.

Ms May’s letter stated that workforce challenges were a “shared concern” between NHS Improvement, NHS England and Health Education England.

It also referred clinical directors to its recently published safe staffing guidance and expectations of how this should be implemented.

It said feedback from providers had highlighted a need for “some detailed implementation tools and workforce safeguards to ensure quality outcomes for patients”.

NHS Improvement has also set up a “safe staffing improvement team” led by senior clinical staff in order “to support the implementation of evidence-based tools and approaches for organisations that require support”. The team has been providing onsite support to trusts.

In recent months, concern has grown that some clinical roles, including registered nurses, could be replaced with cheaper staff. Some of England’s 44 local STPs refer to using generic support staff in place of nurses.


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