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For everyone’s eyes only

HSJ revealed on Wednesday the final safe staffing guidelines for accident and emergency departments, which were completed by experts working at NICE last year but never published after the government suspended its safe staffing programme.

The documents, reproduced on hsj.co.uk, show that the expert safe staffing committee at NICE agreed to recommend minimum nurse ratios for type one emergency departments in order to ensure patient safety. The document also recommends NHS trusts reconsider the way they currently plan nurse staffing levels in A&E in order to make sure they can better meet surges in demand.

The guideline, leaked to us after numerous requests for it to be published were refused by NICE and the government, sets out the process that should be followed to ensure emergency departments are adequately staffed.

Reacting to the publication, the Department of Health said: “A comprehensive programme of work on safe staffing is being led by NHS Improvement and full guidance will be published later this year.”

The Royal College of Nursing said the guideline had established a clear link between the numbers of registered nurses and poor patient outcomes and in a statement it said it was concerned that fears over the financial consequences of the guideline “may have been a factor in the decision to scrap this important work”.

In a statement, shadow health ministerJustine Madders said: “Safe staffing levels are essential for patient safety and were a key recommendation of the Francis report.

“The government’s decision to block these guidelines from being published is deeply concerning and raises a lot of questions about the ability of experts to give independent advice to the NHS.

“Ministers need to urgently set out how they intend to tackle the workforce crisis in the NHS and ensure hospital wards are not left dangerously understaffed.”

A better or worse BCF?

HSJ analysis has demonstrated that the contribution made by some clinical commissioning groups to the better care fund could go down next year.

CCGs are free to put as much money into their local BCF pots as they like, above a minimum amount set in their annual allocations from NHS England. For nearly a quarter of CCGs, that amount reduces in cash terms in 2016-17 compared to this year.

For a small number of CCGs this is simply due to their overall allocations being re-set. But for most, it is because they are receiving low levels of funding growth compared with the average CCG. At a national level the proportion of CCG cash going into the BCF is dropping, because CCG funding is rising next year while the BCF remains nearly static. The cut in BCF contributions for some CCGs reflects this trend.

In those areas with low funding growth it amounts to more money to spend on regular NHS services, although the amounts are generally in the tens of thousands of pounds, rather than the millions.

It is not yet clear whether this will knock through into a cut in funding for social care in the areas affected – the BCF has been used to protect social care funding this year. Councils we spoke to said they were still talking to their CCGs about next year’s better care fund settlement.