Exclusive: NICE safe staffing U-turn followed meeting with Hunt's office

According to emails obtained by HSJ, National Institute for Health and Care Excellence chief executive Sir Andrew Dillon overturned plans to publish safe staffing evidence immediately after receiving an email from Kristen McLeod, the health secretary’s principal private secretary.

The 28 July email from Ms McLeod to Sir Andrew, which followed a conversation between the two, says they had agreed that publishing NICE’s safe staffing work at that time would be “confusing for staff and the public”.

An email sent two minutes later by Sir Andrew to his senior team at NICE informed them that the information would now not be released as planned on 30 July. He wrote: “DH have, this afternoon, confirmed that they will arrange for the final version of our work on A&E safe staffing to be released as part of the evidence base for the safe staffing advice that NHS England and NHS Improvement will be publishing.”

He added that in “these (changed) circumstances” NICE will “not be releasing the guidance on 30 July because it is intended to be published at a later date”.

NICE had previously said it would publish its safe staffing evidence on 30 July despite NHS England asking it to suspend the work in June. The work was recommended by Sir Robert Francis after his public inquiry into poor care at Mid Staffordshire Foundation Trust.

Although the series of emails is heavily redacted, they do reveal correspondence by Sir Andrew dated 23 July to NICE staff, including commitments to release the accident and emergency evidence – albeit with changes to make clear it was no longer official guidance.

The intervention of Mr Hunt’s office followed a 24 July email from an unnamed senior Department of Health policy manager to Mark Baker, NICE’s centre for clinical practice director, requesting an “advance copy of the A&E staffing guidance/report” before it was published at the end of that month.

In a response sent on the same day, Lorraine Taylor, associate director of safe staffing guidance, included a copy of the A&E guidance and said NICE planned to make the “final version of the report available by request only at the end of the month (30 July)”.

On 28 July, Ms McLeod emailed Sir Andrew. She said: “I thought it would be helpful to confirm in writing our conversation. We agreed that it could be confusing for staff and the public if NICE were to release one piece of work on safe staffing now without any context and in isolation of any final guidance on safe staffing levels. However, we both agreed that this work should be put in the public domain as soon as is practically possible.”

New regulator NHS Improvement is to continue developing safe staffing guidance under the leadership of NHS England patient safety director Mike Durkin. Following concerns over the decision to suspend NICE’s work, Mr Hunt said the final guidance would be reviewed by the body.

Ms McLeod’s email went on to say that NICE’s work should be published by NHS Improvement “as part of a package of supporting evidence at the same time as the final safe staffing guidelines are published”.

The DH refused to answer questions about the conversation between Sir Andrew and Ms McLeod. It has previously said no pressure was put on NICE not to publish.

A NICE spokeswoman said: “We do not believe the emails show an inappropriate attempt to influence NICE and Andrew Dillon against publishing the safe staffing evidence. The Department of Health expressed its views and these were taken into consideration.”

The emails, released after a freedom of information request, also show NICE was originally planning to publish more documents on 30 July, including:

• economic analysis and modelling reports;
• field test reposts;
• evidence reviews;
• an equality impact assessment; and
• responses from stakeholders to its consultation.

NICE has refused to release the A&E guidance and its four evidence reviews of safe staffing levels to HSJ under FOI legislation. NICE said: “We believe that there is the potential to disrupt the effective management of the health service by publishing the evidence reviews at this time.

“Publication is likely to give rise to further public interest and generate enquiries about the work, which has the potential to delay NHS Improvement’s work. Safe staffing is very much a live issue for the NHS and we believe it’s important that NHS Improvement has safe space to develop and reach its own conclusions as it develops its guidelines. Disclosure at this stage would likely make it harder for NHS Improvement to undertake their work.”