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”
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.