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Francis criticises cessation of NICE work on safe staffing guidance

  • 5 Comments

Sir Robert Francis has expressed serious concerns over the decision to suspend the programme of work that he recommended to determine safe nurse staffing levels.

The chair of the public inquiry into care failings at the former Mid Staffordshire NHS Foundation Trust spoke out after it was revealed yesterday that the National Institute for Health and Care Excellence had ceased its work on safe staffing guidance.

The programme by NICE was a specific recommendation made by Sir Robert in his high profile 2013 report, which was immediately accepted by health secretary Jeremy Hunt.

“I specifically recommended the work which NICE has been undertaking for a reason”

Robert Francis

In a leaked email revealed on Wednesday, NICE chief executive Sir Andrew Dillon said the programme’s work would be suspended with immediate effect.

It followed Mr Stevens announcing yesterday that chief nursing officer for England Jane Cummings would include safe staffing in a series wider service reviews. He suggested the takeover by NHS England would avoid “a more mechanistic approach” of nurse ratios.

Nursing Times’ sister title Health Service Journal NHS England chief executive Simon Stevens has reported that the decision to halt the programme followed a conversation between Sir Andrew and NHS England chief executive Simon Stevens.

In a subsequent interview with HSJ, Sir Robert said he was “surprised and concerned” by the latest development and pointed to the fact NICE was set up to be independent of the NHS and the wider policy structures.

Sir Robert, who is also a board member of the Care Quality Commission, said: “While there is nothing wrong and indeed everything to be said for NHS England reviewing staff levels, I specifically recommended the work which NICE has been undertaking for a reason.

“They have an evidenced based and analytical approach, which I believed would be very helpful in filling what appeared to be a gap in the discussions on this topic,” he said.

“NICE also has an advantage not enjoyed by NHS England of being independent,” he said.

“It is important to establish practical guidance, based on the needs of patients, which will enable providers, commissioners and service users alike to understand whether a particular service is safely staffed,” said Sir Robert.

“I will hold their feet to the fire to make sure we continue the excellent progress we’ve made towards safe staffing”

Jeremy Hunt

He added: “I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of NICE has been stopped.”

Responding to concerns about the change, health secretary Jeremy Hunt said that he would personally ensure progress continued on safe staffing.

“I am the secretary of state who is responsible for implementing the Francis report, and there will be no higher commitment. Whoever is responsible for that work, I will hold their feet to the fire to make sure we continue the excellent progress we’ve made towards safe staffing,” he said.

However, Mr Hunt said he supported NHS England’s decision to ensure “a better way of measuring safe staffing, which is more subtle than simply numbers of bodies per shift”.

But Royal College of Nursing chief executive and general secretary Peter Carter said: “If staffing levels are not based on evidence there is a danger they will be based on cost. We must not repeat the mistakes of the past.”

NHS England declined to respond to a request for comment.

  • 5 Comments

Readers' comments (5)

  • This obvious assault on safe staffing is awful beyond words. The effects are predictable and successive NHS staff surveys, RCN surveys, Nursing Times surveys and others have shown that inadequate staffing levels are a key, if not the key stressor and risk.

    Also striking in all these surveys is the astronomical levels of suppression and bullying in response to staff raising concerns about unsafe working conditions. This year, a new measure in the national staff survey revealed that almost a third of staff do not feel secure in raising concerns. The Health Service Journal calculated that this amounted to 100,00 scared staff nationally. It also acknowledged that this was "not just a burden to staff, but a threat to patients".

    Robert Francis is entirely right to add his voice concerns. He makes a crucial point on the need for independent processes where the protection of patients' interests are at hand.
    This is plain common sense and the learning from many inquiries into NHS disasters.

    One major issue raises its ungainly head though. Robert Francis badly failed whistleblowers earlier this year by failing to provide anything approaching adequate protection in his Freedom to Speak Up report.
    He discarded the need for truly independent process and left control in employers' hands. He also suggested that NHS England, (which he now disparages as not being independent) should be one of the bodies overseeing whistleblower welfare. Robert Francis also dropped his past support for deterrent criminal sanctions against those who victimise whistleblowers. To put it politely, he has been inconsistent.

    To cap it all, he advised against a public inquiry into whistleblowing, although this is what whistleblowers have asked for.

    If Robert Francis is now having doubts about this government's commitment to patient safety, I entreat him to search his conscience and lend his support to a public inquiry into NHS whistling. There is so much still hidden that threatens patients, and he knows this only too well from the evidence of hundreds of whistleblowers. People need to speak, and there must be sunlight for the sake of patients.

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  • Apologies for a typo above. The figure is 100,000 and not 100,00.

    Less haste more speed!

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  • Very interesting and informative comments above. However I would challenge the use of the description "threat to patients."

    Currently, still, patients are actively harmed by what goes on now - not simply under threat.

    Soon I attend a Coroner's inquest for an elderly person with complex needs including dementia. Already there are so many omissions in reports by GP, Care Home Provider (no registered home manager there, a crazy quantity of agency nurses employed and instigation + maintenance of unlawful practices at the home by NHS funding manager), the pathologist, the coroner's court, etc. There is no way that a fair inquest can happen now.

    All these omissions have to be condoned by Whitehall and/or whichever govt is in power at the time. They did not arrive en masse overnight.

    Did you know that a coroner's court has not delivered a finding of unlawful death for someone in state detention (which includes detained in care homes under DoLs, prisons and hospitals) for 30 years?

    The bully culture in this country is colossal. And many of the bullies are very sleek and devious, as well as charming and plausible, and top of the pile, of course.

    It's time every one of us started using our brains and looking beyond the nice but tricky facades.

    Psychologists reckon that simply frowning can inhibit behaviour. Maybe we should start a mass "frown campaign" against those in authority who abuse that authority to the detriment of patients and whistleblowers if we are too frightened to speak up and have our words twisted??

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  • ps I have a lot of empathy for the situation Sir Robert Francis QC finds himself in; it is devastating to believe you are going to work as part of a team towards moving practice from inhumane to decent then find that those with the real power are just duplicitous.
    All good luck to him.

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  • michael stone

    Good - I commented about NICE's experience in making 'evidence-based assessments' in the other NT one about this, and I'm pleased that Sir Robert has said the same thing:

    'Sir Robert, who is also a board member of the Care Quality Commission, said: “While there is nothing wrong and indeed everything to be said for NHS England reviewing staff levels, I specifically recommended the work which NICE has been undertaking for a reason.

    “They have an evidenced based and analytical approach, which I believed would be very helpful in filling what appeared to be a gap in the discussions on this topic,” he said.'

    I do like Sir Robert's forthright comments, when people start to 'cherry pick' his reports. Mind you, there was a hint in the way that he made his original report very difficult to 'cherry pick' - so nobody should be surprised, at his 'ire'.

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