Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

'Leaked guidance backs ratios despite u-turn'


NHS conspiracy theorists would have considered last week’s story on safe staffing guidance for A&E as vindication of their suspicious natures.

It revealed that, contrary to statements last year from senior leaders in healthcare, staff ratios really do matter.

Work on safe staffing guidance started by NICE in the wake of The Francis Report into care failings at Mid-Staffordshire was halted in June last year, and taken over by NHS England. However, the news was followed by a flurry of, well, inactivity and silence. 

”No one seemed to have a plan for how to manage safe staffing”

No one seemed to have a plan for how to manage safe staffing, and any comments on the issue were limited to suggestions that multidisciplinary teams are the way forward and that nurse to patient ratios are not essential – without any evidence to back that up.

Evidence seems to be a nice-to-have rather than a must-have for those in charge of whether to make staffing ratios mandatory. They seem to regard safe staffing as a kind of alchemy – take the word multidisciplinary, sprinkle on some mentions of “skill mix” and suddenly you have a gleaming service that has no need to think about having adequate numbers of nurses to provide safe care.

Monitor, NHS England and the Trust Development Authority all wrote to provider organisation nursing directors last autumn, giving pretty much the same message – that NICE’s earlier guidance on general adult wards of 1:8 was only a guide, and they shouldn’t feel compelled to hit that ratio.

”It seems plausible that NICE’s work was halted because it was going to prove too costly to implement”

Not according to NICE – which actually did some work in this area to produce evidence, rather than just relying on alchemy.

The leaked A&E NICE guidance, which HSJ reporter Shaun Lintern got hold of last week, reveals that the organisation did believe ratios are essential. It specified the number of registered nurses to patients, depending on their priority level and the reason they had been brought to A&E.

It seems plausible, then, that NICE’s work was halted because it was going to prove too costly to implement.

Perhaps NHS Improvement, which is to take over this work from NHS England, will have more of a plan as to how to set national guidance on the number of nurses needed to safely look after patients.

But will its guidance be driven by cost rather than need and safety demands? If so, nurses are going to need a bit of real magic to keep their patients safe.


Readers' comments (3)

  • How does this tie in with nursing ratios and a 24/7/365 and better waiting times in A&E and reductions in hospitalisation for the elderly?

    Hospitals told to cut staff amid spiralling NHS cash crisis

    Exclusive: Nurses’ jobs threatened as regulators ditch policy brought in after Mid Staffs scandal

    Unsuitable or offensive? Report this comment

  • michael stone

    Jenny, surely you have phrased this wrongly ?:

    'No one seemed to have a plan for how to manage safe staffing,'

    Isn't it actually:

    'No one seemed to have a plan for how to achieve safe staffing levels,'

    'The NHS powers-that-be' seem quite willing to haggle about how to 'manage' the staff they already have, but what they seem unwilling to be open about is any evidence which 'proves' there needs to be more staff available to be managed.

    Which, you did say in the article - it is just that phrase, I'm wondering about.

    Unsuitable or offensive? Report this comment

  • Jenni Middleton

    Yes Michael, I think we both agree. As you say, if you read the whole article, you get my point.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.