Concerns have been raised by the Royal College of Nursing and Unison that the suspension of work on a national programme of guidance on safe nurse staffing levels may be down to affordability issues.
The union is calling for reassurance this was not the reason behind the decision to halt the programme, which is run by the National Institute for Health and Care Excellence.
“We are concerned that this move is driven by affordability”
An internal email sent yesterday, seen by Nursing Times’ sister title Health Service Journal, revealed that NICE chief executive Sir Andrew Dillon had put the programme on hold.
In a statement, Sir Andrew said he had made the decision following an announcement by NHS England chief executive Simon Stevens indicating his organisation would be taking on this responsibility for the future.
The RCN described NICE’s work so far on nurse safe staffing as “excellent….rigorous, well researched and respected”.
Under the programme, NICE has published final guidance on safe nursing levels in adult inpatient wards and midwifery levels in maternity units.
The college questioned the reasons for suspending further publication of guidance on safe nurse staffing levels – which was still due to be completed for accident and emergency, community and mental health settings .
It noted that “if staffing levels are not based on evidence there is a danger they will be based on cost”.
RCN chief executive and general secretary Peter Carter said “We must not repeat the mistakes of the past, where staffing levels were cut to save money, and patients suffered as a result.
“We are concerned that this move is driven by affordability, and patients and staff must be assured that this is not the case,” he said.
He added that nurses were under “a great deal of pressure” and that the NICE guidelines played a “vital” role in supporting them.
“Whatever replaces the NICE guidelines must continue to emulate their evidence based and safety focused approach. Straying from this course now would be failing both staff and patients,” he warned.
“There was clearly a fear that the forthcoming guidance would mean yet more need for agency nurses”
Unison head of nursing Gail Adams said: “It’s surely no coincidence that since NICE came up with recommendations concerning the numbers of nursing staff needed in acute clinical settings, there are now more nurses – both agency and NHS – working.
“With NICE’s work well underway on the safe staffing levels needed in maternity, mental health and community services – areas of the NHS that are chronicallyunderstaffed – there was clearly a fear that the forthcoming guidance would mean yet more need for agency nurses,” added Ms Adams.
“Increasing the numbers of nurses on wards might cost more money, but it also means improved patient care and safety,” she said. “Today’s decision will do little if anything to engage and build public confidence.”
The guidance programme was a recommendation of the Francis report into Mid Staffordshire Foundation Trust.
Sir Robert Francis said NICE should draw up “evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix.”
Following the inquiry report, NICE was asked by Department of Health to draw up guidelines to ensure adequate nurse staffing levels for nine healthcare settings including acute wards, A&E departments, maternity, mental health, and community services.
Guidance on safe staffing for nursing in adult inpatient wards in acute hospitals was subsequently publishing in July last year, followed in February this year by guidance on safe midwifery staffing for maternity settings.
Meanwhile, a draft version of guidance on safe nurse staffing in A&E was put out for consultation in January. The final version was due to be published in May but was held up by the ban on politically sensitive announcements in the run-up to the general election – the period known as “purdah”.