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Shock as NICE halts work on nurse staffing levels guidance

  • 14 Comments

The National Institute for Health and Care Excellence has suspended with immediate effect its work to determine safe staffing levels across the NHS, an internal email has revealed.

The creation of the programme of guidelines on safe staffing levels was a recommendation of the Francis report into care failings at the former Mid Staffordshire NHS Foundation Trust and the decision to halt it has sparked strong criticism from nursing workforce experts.

“I have taken the decision to suspend further work on our safe staffing programme”

Andrew Dillon

Together with new NHS rules requiring trusts to publish data about nurse staffing levels, the NICE guidance has been widely credited with helping drive the recruitment of permanent nursing staff in recent years.

The instruction to stop the programme was contained in an email from NICE chief executive Sir Andrew Dillon to members of the safe staffing programme, which was sent on Wednesday and  seen by Nursing Times’ sister title Health Service Journal.

“I have taken the decision to suspend further work on our safe staffing programme, including any further meetings of the advisory committee,” said Sir Andrew in the message.

Sir Andrew Dillon

Sir Andrew Dillon

He suggested the move was in response to a speech made earlier in the day by NHS England chief executive Simon Stevens at the NHS Confederation conference in Liverpool.

Mr Stevens announced that he had asked chief nursing officer for England Jane Cummings to consider rolling work on safe staffing levels into NHS England reviews of urgent and emergency care, maternity and mental health services.

The move would replace what Mr Stevens called the “more mechanistic approach to the setting of nurse staffing ratios” being used by NICE.

Sir Andrew’s email continued: “Given this announcement, it would not make sense to commission further work from the programme.”

However, it was described as “dangerous for patients and a backward step” by Susan Osborne, the chair of the Safe Staffing Alliance campaign group and a former nursing director.

She said she was “shocked” at the decision. “They are not recognising that trusts up and down the country are operating on unsafe staffing levels which must be compromising patient care,” she said.

“This is burying something because it is telling you the answer you don’t want to hear,” she added.

In his report on Mid Staffordshire, Sir Robert Francis said NICE should draw up “evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix.”

“This is burying something because it is telling you the answer you don’t want to hear”

Susan Osbourne

Sir Robert said: “Adoption of these practices, or at least their equivalent, is likely to help ensure patients’ safety.”

Following the inquiry report, NICE was asked by Department of Health to draw up guidelines to ensure adequate nurse staffing levels for nine healthcare settings including acute wards, A&E departments, maternity, mental health, and community services.

Guidance on safe staffing for nursing in adult inpatient wards in acute hospitals was subsequently publishing in July last year, followed in February this year by guidance on safe midwifery staffing for maternity settings.

Meanwhile, a draft version of guidance on safe nurse staffing in A&E was put out for consultation in January. The final version was due to be published in May but was held up by the ban on politically sensitive announcements in the run-up to the general election – the period known as “purdah”.

And, as reported by Nursing Times, NICE issued a call for evidence on safe staffing for community nursing at the end of April as the start point for its next guideline.

Sir Andrew’s email makes clear that guidance already published by the programme – for adult acute wards and maternity settings – will remain in force.

However, the move puts into question the future of draft guidance issued by NICE on A&E departments, which suggested a range of minimum nurse staffing ratios.

A source close to the safe staffing programme said the decision to halt the programme had come “out of the blue”. “While the NICE process is far from perfect it was at least independent and considered evidence,” they told Health Service Journal.

“This is a decision I don’t understand and I fail to see how it can be a good thing”

Jane Ball

Nursing workforce expert and research fellow at Southampton University Professor Jane Ball criticised the programme’s suspension.

She said: “I’m disturbed this decision should be taken when the dangers of a lack of an evidence-based approach and not considering the risks of making changes to staffing levels were described so graphically by Sir Robert Francis in his report on Mid Staffordshire.

“This is a decision I don’t understand and I fail to see how it can be a good thing,” she said.

The guidelines on acute inpatient wards are considered to be one factor that has driven demand for nursing staff and contributed to the runaway costs of agency spending and overseas recruitment.

The decision to stop the safe staffing guidance programme comes in the wake of public pronouncements this week on the need to reign in agency spending from both Mr Stevens and health secretary Jeremy Hunt.

It is currently unclear whether the decision to halt the programme was taken entirely by NICE or was the result of pressure from NHS England.

The government, which originally announced the programme in response to the Francis report, has remained silent so far.

 

In a statement from NICE, Sir Andrew said: “Making sure that hospitals and community services are safely staffed remains an important priority for the NHS. The guidance that NICE has already published on safe staffing levels in adult acute wards and in maternity settings was widely welcomed and will continue to be used.

“The announcement by Simon Stevens of a review of the approach to setting safe staffing levels means that the work to secure safe levels of staffing in A&E departments and in mental health and community settings is likely now to be taken forward as part of NHS England’s wider programme of work to help the NHS deal with the challenges it is facing over the next few years,” he said.

“NICE stands ready to support this work using the experience we have gained over the last two years,” he added.

 

Danny Mortimer, chief executive of NHS Employers organisation, said: “Employers have found NICE guidance on staff staffing levels supportive, but they also tell us they need a conversation about how judgments about safer staffing are applied in practice, particularly by regulators.

“We look forward to working with NHS England chief nursing officer Jane Cummings, as she takes this work forward,” he said.
 

  • 14 Comments

Readers' comments (14)

  • During my son's hospitalisation in a unit which was regarded as a leading A&E specialist unit, the ward has 1 trained staff with all the other staff who informed us that they could not assist with our requests or queries - they were health care assistants!
    This trend is replicated in many areas where no nurse is prepared to spend time with relatives answering any concerns raised regarding care etc.
    NHS is trying to provide low cost care to patients while increasing numbers of professionals who are not providing care but being paid often even more than PM - this drive to keep professionals in posts being paid huge amounts of money is because numbers of trained nurses are being cut while numbers of directors, deputy directors in on the increase - is this an efficient way to provide care, or is the NHS a cash cow for professionals who are no longer providing care but more interested in getting a power base for their territorial needs?

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  • One qualified RMN on night shifts sadly common practice on mental health wards nowadays.

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  • There are absolutely no areas in healthcare that do not now contain large numbers of non registered health care workers. Although many carry out tasks previously performed by registered nurses and provide valuable support to patients, there are limitations to their abilities. They are the cheap options, but ultimately employing fewer registered nurses makes it more difficult to maintain high quality care and good communication with worried patients and relatives.

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  • HCSW

    @ Carol Ellison | 4-Jun-2015 9:00 pm

    At my workplace ratio is 60/40 (RGN/HCA). I would advise you bit more care when using the word "absolutely"

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  • Sounds like burying bad news to me; slimey gits.

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  • oh well no surprise then, how long will it be till no registered nurses and we have care workers employed at less than the minimum wage

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  • My reaction is one of relief. The approach that appeared to be being taken here (and is in Wales) is simplistic and in studied ignorance of what works in risk management and what doesn't. Minimum staffing levels sent down from on high will create gaming, will deprive the areas not covered by the legislation of staff, and would cost lots of money.

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  • Anonymous | 4-Jun-2015 9:40 pm

    that I read in NT five years ago seemed to be the plan with more ward teams comprising HCAs carrying out basic care and taking on more nursing tasks and degree qualified RNs in more and fewer supervisory, advisory roles leaving them more time for all the paperwork :-(.


    on paper this could certainly appear to a lay manager a cheaper short term option without taking into account any understanding of the diverse roles of nursing and the outcomes and risks when there are no longer enough qualified staff to carry them out!

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  • from Anonymous | 4-Jun-2015 9:40 pm above

    this is such an old fashioned way of commenting where other readers cannot be replied to directly or their comments voted on in agreement or disagreement. sometimes a tick is all that is needed rather than having to write a reply.

    why can't EMap join Disqus or some similar platform. it also saves readers of whom the majority are nurses precious time and can lead to more flowing and constructive discussions.

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  • from Anonymous | 4-Jun-2015 9:40 pm above


    ... oh and the editing and delete features are also useful and can be used to make alterations and additions to comments after posting.

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