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NHS leaders defend decision on safe staffing


NHS England’s leaders have mounted a defence of their controversial plans to take over work on safe staffing guidance, claiming their approach has the backing  of many directors of nursing.

The response from the government arms-length body’s chief executive and the chief nursing officer for England follows a fortnight of vocal criticism of the move from nursing organisations and individual nurses, often via social media.

Last week CNO Jane Cummings revealed further details about her plans for taking on the work on safe staffing guidance, which until two weeks ago was being carried out by the National Institute for Health and Care Excellence.

Following a recommendation from the Francis report, NICE had begun to produce safe nurse staffing guidance across a range of settings. It had published guidelines for adult inpatient wards, maternity settings and was on the cusp of publishing guidance for accident and emergency departments.

The surprise decision by NHS England to suspend NICE’s work on the guidance – which was revealed in a leaked email – was met with shock and criticism by many in the profession.

Questions were raised about whether the decision had been made due to financial concerns around agency spending and whether NHS England would be able to produce independent guidance and if it had the resources to do so.

On Thursday, in attempt to regain the initiative, the CNO published an open letter to nursing directors to dispel “misconceptions” about the decision and to outline the “next steps”.

On the same day she appeared on a panel at a conference alongside NHS England chief executive Simon Stevens.

Speaking at Nursing Times’ Deputies Congress, Ms Cummings said that once she had provided further detail on her plans, she had received a “positive” response from directors of nursing.

“There definitely have been concerns raised. We wanted to have a plan that we were able to articulate clearly which wasn’t ready [initially]. It is ready now and we will build on that over the coming weeks,” she said.

She reiterated the importance of having staffing guidance that looked beyond nursing and considered the availability of other members of the multi-disciplinary team.

Ms Cummings also noted NICE’s guidance so far had focused on hospitals, whereas different guideline approaches would be required for mental health, community and other settings.

“We wanted to have a plan that we were able to articulate clearly which wasn’t ready. It is ready now”

Jane Cummings

The CNO argued there was not enough UK evidence available on safe staffing for any setting outside of acute medical and surgical wards, and that NHS England would begin testing models to help create a better evidence base.

She said this would involve working with NICE, the royal colleges, independent experts and frontline clinicians, to look at “outcomes and outputs, experience, effectiveness and safety – as much as the inputs”.

Ms Cummings added: “I had a meeting with 70 nurse directors [on 9 June] and we did go through this in quite a lot of detail… The message back was positive. So I have checked a lot of what we are doing.”

Also speaking at the conference for deputy nursing directors, Mr Stevens acknowledged NICE’s guidance so far had been “helpful”.

But he added: “The question is – as we now look at how we expand the conversation about safety and safe staffing across out-of-hospital settings, can you apply the same methodology as you do for an acute inpatient ward?”

He said the “team-based” approach to care in out-of-hospital settings required a “more flexible” way of producing staffing guidance than the “more prescriptive” methods used for inpatient settings.

But the Royal College of Emergency Medicine issued a warning saying NHS England must “speedily” publish guidance for A&E settings, based on NICE’s work, to avoid compromising patient safety.

“[NICE’s] work was informed by expert opinion and experience and would have been a step change to ensure patient safety was indeed at the heart of urgent healthcare,” said the college in a statement. “The current situation and enormous variability in nurse staffing levels is unjustifiable.”

Meanwhile, a member of NICE’s staffing advisory committee has urged nurses to start publishing their own evidence, after questioning whether future guidelines on A&E nurse staffing will be as robust as NICE’s draft version.

In the initial aftermath of the announcement, Safe Staffing Alliance chair and former director of nursing Susan Osborne described the move as “dangerous for patients and a backward step”.

Sir Robert Francis also criticised the decision, saying it “surprised and concerned” him and pointed to the fact NICE was set up to be independent of the NHS and wider policy structures.

Mental Health Nursing Academics UK echoed these issues, stating it had “serious concerns” whether NHS England’s mental health taskforce – which is to work on safe staffing guidance for mental health settings – had the required capacity, resources or expertise to carry out a comprehensive review.


Readers' comments (12)

  • michael stone

    NHS England's leaders can defend the decision as much as they want to - but the gathering of the 'evidence base' for this should have been left to NICE, because it is, as I've stated previously, 'NICE's day job'.

    There is surely a clue, in the sheer number of different people and organisations who have come out and criticised this decision.

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  • Agree with Michael Stone's comment.
    The nursing profession has previously suffered from a lack of good leadership, which was a factor (among others) in major scandals of poor care. Now there is an opportunity to work with NICE to ensure that safe staffing becomes the norm. This opportunity should be grasped now, not left to disappear in the same way as the PM Commission on the Future of Nursing did!

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  • "Directors of nursing", eh?

    That'll be those who have overseen and colluded with cuts to nursing numbers, experienced senior nurses being forced out of their jobs, consequent reduction in service provision, cosying up to finance directors, helping to bury critical reports into their trusts' staffing and the like...

    All while trousering pay rises of, in the case of my old director of nursing, 9% while the rest of us got SFA, from their "off A4C" posts whose salaries and benefits are not made public...It is possible to find the details, but they don't make it easy.

    It is them, isn't it? Or is there another group of "directors of nursing" I don't know about?

    'Cos that bunch just love independent scrutiny of their actions, don't they?

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  • Well said all

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  • nursing directors who tell senior sisters off for putting in incident forms if the staff is dangerously low (i.e 2 nurses for 15 patients, 4 of whom are high dependency level 2 patients)! nursing directors who say to do such a thing would make them look bad. nursing directors who deliberatley change staffing status from red to green to make everything seem fine.

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  • what a load of bo***cks! i worked in the nhs for 7 years and there was never enough staff per ratio of patients, please dont pretend this is only just being realised, shame on incompetent managers, shame on incompetent nursing directors, shame on them all, what a travesty for the patients who have suffered or died, and staff who couldnt cope with the workload while waiting for someone in authority with a set of balls to do something about it.

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  • Well said all.
    Directors of Nursing…….sell outs the lot of them.

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  • Safe Staffing levels have been with the care sector ages ago. Be it the NHS or Independence Healthcare Providers. It has been echoed now because of Adult Safeguarding alerts and education. The chronic shortages of staff are un-ending perennial problem due to lots of things. To mention a few , incompetent and knee jerking management , the lack of proper understanding of adult safeguarding issues by many professionals in health and social care. Lack of clarity of same by health and social care directors, the judicially and poor understanding of the public due to poor information dissemination .The hard working front line health and social care professionals are almost always victimized, their lives shattered, and many more. This has contributed immensely to staff shortages in all grades . not talking of persons who are leaving for fear of being the next victim. Lastly but not the least the continuous shortages of front line staff further puts a lot of stress on the working staff, hence motivation ,compassion , committed to go to work is weakened. This has also got serious effects on staff health and well being, sickness on the rise, leaving care settings with shortages. WHEN DOES THIS END.

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  • And as ever the BTL comments on here show how out of touch our "leaders" actually are...

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  • Well of course we need another expensive review to analyse the problem we already know, create a post and justify my existence........

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