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Call for review of decision to halt NICE staffing guidance

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The Royal College of Nursing and the Safe Staffing Alliance have called for a review of the decision to suspend the National Institute for Health and Care Excellence’s work on producing safe staffing guidance for nurses.

They said the decision – which will see NHS England take over the programme – risks patient safety returning to the standards in place before the inquiry into care failings at Mid Staffordshire Foundation Trust.

“There is a risk we are taking away a fundamental building block that Sir Robert Francis said we needed to put in place to ensure patient safety”

Howard Catton

They noted that the move directly contradicted a key recommendation made by Sir Robert Francis in his 2013 report on Mid Staffordshire, which specifically recommended NICE produce the guidance on staffing as it was independent of government.

The Francis report also said that certain other bodies – such as regulators and the royal colleges – should be involved in the process to help compliance with the guidelines.

Highlighting this point, RCN head of policy Howard Catton said a review of the decision to halt the NICE programme was needed and that it should include the institute, NHS providers, the regulators the Care Quality Commission and Monitor, and the royal colleges of nursing and midwifery.

“The decision to suspend NICE’s work feels to me as though there is a risk we are taking away a fundamental building block that Sir Robert Francis said we needed to put in place to ensure patient safety,” said Mr Catton, speaking at a HealthCare Conferences UK event on Monday.

“Given what [Sir Robert] said and the decision that has been taken, I think there is a place for us to review the decision to suspend NICE,” he said.

“If we do that quickly [stop NICE from developing future guidance], and if we’ve got it wrong, the risk is we put ourselves back to the position we were in before Mid Staffordshire happened,” he added.

Susan Osborne, chair of the Safe Staffing Alliance campaign group and a former nursing director, said NICE must be reinstated to lead the development of guidance on safe nursing levels, because it was an independent body with the resources to carry out such work.

In contrast, she told Nursing Times that NHS England was “not set up to do this work and it has no independence”.

“NHS England is not set up to do this work and it has no independence”

Susan Osborne

Referring to recent questions around whether the decision to transfer the work to NHS England was financially motivated, she added: “No one has yet quantified how much money is needed to get to safe staffing levels or looked at the fact that if you invest you can become more efficient. This is all very short-term thinking.”

In a letter due to be published in The Times today, the alliance urges health secretary Jeremy Hunt to ask NICE to resume its work on safe staffing.

The letter acknowledges that “at a time of increasing financial constraint when services are struggling to recruit and retain nurses, responding to the evidence on safe staffing will doubtless pose huge challenges”.

However, it says for this reason the need for independent and evidence-based guidance has “never been greater”.

Also speaking at the event was Ruth May, newly-appointed nursing director at Monitor and until recently NHS England’s regional chief nurse for the Midlands and East region. She said she had not yet seen any plans about how the work would be taken forward.

However, she said that nurses, including herself, who were involved in NICE’s work would still be available as a resource to “tap into” for developing future guidance.

NICE’s decision to suspend its work on safe nurse staffing guidance was uncovered last week after an internal email revealed that NICE chief executive Sir Andrew Dillon had put the programme on hold.

NICE later released a statement saying NHS England had asked it to stop all further work on the programme.

The body has produced guidance for adult inpatient awards in acute hospitals and maternity settings, which will still be in force.

However, guidelines on safe nurse staffing in A&E which were about to be published will not come into effect and future guidance for other settings such as the community and mental health are not planned to go ahead.



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Readers' comments (2)

  • michael stone

    'NICE later released a statement saying NHS England had asked it to stop all further work on the programme.

    The body has produced guidance for adult inpatient awards in acute hospitals and maternity settings, which will still be in force.

    However, guidelines on safe nurse staffing in A&E which were about to be published will not come into effect and future guidance for other settings such as the community and mental health are not planned to go ahead.'

    If NICE has completed its work for some settings, was about to publish for A&E (and that work is 'being thrown away at near-completion'), and is stopping work for other settings, the guidance about safe staffing levels will probably be 'inconsistent' - not a good situation, I suspect.

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  • Or it may be very consistent in saying that staffing levels are woefully low and encouraging the government to invest shed loads of money on ore training places and many more nurses.

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