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Unions make link between guidance suspension and staffing costs


Concerns have been raised by the Royal College of Nursing and Unison that the suspension of work on a national programme of guidance on safe nurse staffing levels may be down to affordability issues.

The union is calling for reassurance this was not the reason behind the decision to halt the programme, which is run by the National Institute for Health and Care Excellence.

“We are concerned that this move is driven by affordability”

Peter Carter

An internal email sent yesterday, seen by Nursing Times’ sister title Health Service Journal, revealed that NICE chief executive Sir Andrew Dillon had put the programme on hold.

In a statement, Sir Andrew said he had made the decision following an announcement by NHS England chief executive Simon Stevens indicating his organisation would be taking on this responsibility for the future.

The RCN described NICE’s work so far on nurse safe staffing as “excellent….rigorous, well researched and respected”.

Under the programme, NICE has published final guidance on safe nursing levels in adult inpatient wards and midwifery levels in maternity units. 

The college questioned the reasons for suspending further publication of guidance on safe nurse staffing levels – which was still due to be completed for accident and emergency, community and mental health settings .

It noted that “if staffing levels are not based on evidence there is a danger they will be based on cost”.

Royal College of Nursing

Peter Carter at the health select committee

RCN chief executive and general secretary Peter Carter said “We must not repeat the mistakes of the past, where staffing levels were cut to save money, and patients suffered as a result.

“We are concerned that this move is driven by affordability, and patients and staff must be assured that this is not the case,” he said.

He added that nurses were under “a great deal of pressure” and that the NICE guidelines played a “vital” role in supporting them.

“Whatever replaces the NICE guidelines must continue to emulate their evidence based and safety focused approach. Straying from this course now would be failing both staff and patients,” he warned.

“There was clearly a fear that the forthcoming guidance would mean yet more need for agency nurses”

Gail Adams

Unison head of nursing Gail Adams said: “It’s surely no coincidence that since NICE came up with recommendations concerning the numbers of nursing staff needed in acute clinical settings, there are now more nurses – both agency and NHS – working.

“With NICE’s work well underway on the safe staffing levels needed in maternity, mental health and community services – areas of the NHS that are chronicallyunderstaffed – there was clearly a fear that the forthcoming guidance would mean yet more need for agency nurses,” added Ms Adams.

“Increasing the numbers of nurses on wards might cost more money, but it also means improved patient care and safety,” she said. “Today’s decision will do little if anything to engage and build public confidence.”

Gail Adams

Gail Adams

The guidance programme was a recommendation of the Francis report into Mid Staffordshire Foundation Trust.

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.”

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”.


Readers' comments (11)

  • Of course it's all about money. When unsafe staffing levels are made public, they have to be addressed, and that costs a lot of money. So they try to bury the truth. There will be many more mid staffs situations before long.

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  • Is this pressure again from the corridors of Westminster.Nurse have been blammed all along for lack of care -think about the 6 c's but the presumed lack of care was due to low staffing levels which this government will just not address
    So Mr Hunt -if you you want things sorted put your funding in place -fair staffing levels so that nurses can do their job properly and not work through their breaks and incur unacceptable levels of stress
    Come and do a few shifts with us and see what you think and stop paying mangers unacceptable levels of pay -because that is what is happenening So please dont blame us -stand up and be fair -even NICE KNOWS YOU POLICIES ARE A NONSENCE

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  • Stop overspending on agency nurses and give a fair pay deal across the board! I guarantee you, sickness levels will reduce and nurses will feel more valued!
    And I agree with anon 8:25 am, management in nursing is a joke! I'm convinced half these jobs are made up! Get rid of a load of management, most of whom haven't even worked on a ward in the last 10 years and start to value the opinions and ideas of nurses working at the cold front!! It ain't rocket science! Take your lead from the people in the know, ie, front line medical and nursing staff!!

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  • Failing wards fits the governmants agenda of telling the public it isn't working and private healthcare companies need to step up and sort it out. Problem is we all know how that ends.

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  • Absolutely typical of the Tories. The minute they privatise nursing I'm off and I won't be the only one. They won't be happy until the NHS has fallen apart completely. Not long to go now I fear

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  • You are absolutely right Anonymous 1:47pm. That is the government main intention to destroy our NHS. Such well recognised institution with so call bad publicity doesn't help. We need to stand united to prevent the NHS from been destroy.

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  • So safe staffing is on hold at the same time as there is a blitz on agencies....seems dodgy to me.

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  • There are too many Managers getiing large pay and they do not have a clue on what the nurses are doing and going through on the Wards. Therefore when something goes wrong the nurse is blamed when the organization is at fault.

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  • Well done to the unions for making a link my two year old probably could.

    Now, what are they going to do about it?

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  • Understaffing is a very serious situation which is solely the responcibilty of the Management, the trouble is even when (in the case of Stafford) there are blatant and well publised failings nothing is done to the lousy management,
    if this had been the case in Nursing Homes there would have serious repercussions, why is there still no consistency of approach, why is the Trusts Management allowed to get away with it, when is the Nursing Fraternity going to stand up for itself, why doesn't the Union consider strike action ?? then ,maybe the Public will shout and complain more to the Goverment as obviously their complaints fall on deaf ears within the NHS.
    Has anyone thought of bringing in "Safegaurding" when they are worried , that is what they are therefore and they have teeth, try it sometime.

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