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Trusts should use leaked A&E guidance, says royal college


All trusts should use a leaked safe staffing guideline for accident and emergency to analyse their nurse staffing levels and what action to take, according to the president of the Royal College of Emergency Medicine.

The final version of previously unpublished National Institute for Health and Care Excellent guidance on safe nurse staffing levels in A&E was revealed yesterday, as reported by Nursing Times.

The leaked document, uncovered by Nursing Times’ sister title Health Service Journal, had been kept secret for months following the controversial cancellation of NICE’s safe staffing guidance programme by the government.

In response, college president Dr Clifford Mann said the fact A&Es were understaffed against demand half of the time was “statistically irrefutable”. He said his organisation believed the scale of nurse understaffing in A&E departments was as high as 50%.

The guideline had been prepared by experts using a recognised methodology and should have been published officially by NICE when it was completed last year, he told Health Service Journal.

Dr Mann said: “This guidance from NICE highlights what is self-evident on a daily basis in UK A&E departments. Most have insufficient nursing staff to deal with predictable patient attendance patterns.

“The variation in hourly attendance rates was clearly shown by the Nuffield Trust [think-tank] in their report in 2013. This showed that staffing for average hourly attendances ensures not only that you will be understaffed 50% of the time, statistically irrefutable, but more significantly the scale of understaffing may be as much as 50%.”

“Each trust should undertake a gap analysis and thereby achieve an understanding of the staffing levels they require”

Clifford Mann

He added: “The guidance should be published and each trust should undertake a gap analysis and thereby achieve an understanding of the staffing levels they require.”

Dr Mann said shortages were caused by a lack of available staff but also issues related to burnout from stress and overwork. “Safely staffing a department would address the latter and hence the former whilst improving patient care and outcomes,” he said.

A spokesman for the Care Quality Commission said it expected NHS trusts “to use any tools they deem appropriate to ensure they provide patients with the safe, high quality and compassionate care they deserve”.

CQC chief inspector of hospitals Sir Mike Richards said the regulator supported the principle of staffing levels in A&E being based on patient need, but it would vary according to complexity, volume and care those patients required.

Clifford Mann

Clifford Mann

Clifford Mann

He said: “We ask trusts to provide us with information on planned and actual staffing levels on each shift, so that we can assess any gaps. Also, we observe care delivery and look at reporting of incidents related to poor staffing.

“If we find that A&E departments are not as safe, caring or responsive as they should be, and if we find staffing levels are related to poor care, we will require improvements to be made in the best interests of patients,” he said.

He added that, while the leaked documents were not official NICE guidelines, he expected “NHS trusts to continue to ensure their staffing arrangements are able to meet the needs of their patients effectively”.

The Department of Health said the leaked documents were not official guidance and should not be treated as such.

NHS Improvement, the new body being formed from the regulators Monitor and the NHS Trust Development Authority, is expected to produce new safe staffing guidelines later this year, which will be reviewed by Sir Mike, NICE and Sir Robert Francis.

NHS England and Monitor would not say what action they expected trusts to take following the publication of the leaked NICE guideline.

Labour shadow health minister Justin Madders said: “The government’s decision to block these guidelines from being published is deeply concerning and raises a lot of questions about the ability of experts to give independent advice to the NHS.”


Readers' comments (4)

  • Doesn't it strike people as odd that last year and inclusive of the the government denying the NICE evidences on staffing that there were numerous trusts reported for safety and staffing issues? Including odd that the government is presently attempting to push through a Union Bill, which is hostile towards health and safety? What are trusts and the CQC hiding? Has there been an anti-union move behind closed doorstep to suppress truth and hasten privatisation. If true I believe the game is almost up for the government. If the unions know and are talking why aren't they standing up for the truth? Come on unions ,front-line workers and patients in A&E and emergency services are suffering.

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  • Why o why is the RCN not saying the same thing as the doctors about their own constituency of nurses

    Come on RCN lead or perish!

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  • Lots of conspiracy theory's here. I don't trust the government with the management of the NHS. They are shrinking the workforce and keeping us under pressure with higher flow of patients and lack of staff. It will break the NHS and they know it. That's their grand plan, to run it into the ground. Privatisation is inevitable. Unless we take it back and stand up for patient safety and our selves.

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  • If only it were conspiracy the evidence is before us as clear as day.

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