The National Institute for Health and Care Excellence has suspended with immediate effect its work to determine safe staffing levels across the NHS, HSJ can reveal.
The decision appears to mark a significant departure from recommendations of the Francis report.
NICE moved to suspend work on the safe staffing programme yesterday, in response to a speech by NHS England chief executive Simon Stevens to the NHS Confederation conference in Liverpool.
In an email seen by HSJ, NICE chief executive Sir Andrew Dillon told members of the safe staffing programme: “I have taken the decision to suspend further work on our safe staffing programme, including any further meetings of the advisory committee.”
This was prompted by Mr Stevens announcing that he had asked chief nurse Jane Cummings to consider rolling work on safe staffing levels into NHS England reviews of urgent and emergency care, maternity and mental health services, in place of what he called a “more mechanistic approach to the setting of nurse staffing ratios”.
Sir Andrew’s email continued: “Given this announcement, it would not make sense to commission further work from the programme.”
The decision by NICE has sparked criticism from nursing experts and was described as “dangerous for patients and a backward step” by the chair of the Safe Staffing Alliance and former nursing director Susan Osborne.
She told HSJ she was “shocked” at the decision. She added: “They are not recognising that trusts up and down the country are operating on unsafe staffing levels which must be compromising patient care. This is burying something because it is telling you the answer you don’t want to hear.”
In his report on the scandal of poor care at 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”.
Sir Robert said: “Adoption of these practices, or at least their equivalent, is likely to help ensure patients’ safety.”
Following the inquiry report, NICE was asked by the Department of Health to draw up guidelines to ensure adequate nurse staffing levels for nine healthcare settings including acute wards, [accident and emergency] departments, maternity, mental health, and community services.
Sir Andrew’s email makes clear that guidance already published by the programme – for adult acute wards and maternity settings – will remain in force.
However, the move puts into question the future of draft guidance issued by NICE on A&E departments, which suggested a range of minimum nurse staffing ratios.
A source close to the safe staffing programme told HSJ: “This seems rather precipitate and out of the blue. While the NICE process is far from perfect it was at least independent and considered evidence.”
Guidelines on acute inpatient wards issued last year are considered to be one factor that has driven demand for nursing staff and contributed to the runaway costs of agency spending and overseas recruitment.
Nursing workforce expert and research fellow at Southampton University Jane Ball, told HSJ: “I’m disturbed this decision should be taken when the dangers of a lack of an evidence based approach and not considering the risks of making changes to staffing levels were described so graphically by Sir Robert Francis in his report on Mid Staffordshire.
“This is a decision I don’t understand and I fail to see how it can be a good thing.”
In a statement to HSJ last night, Sir Andrew said: “Making sure that hospitals and community services are safely staffed remains an important priority for the NHS. The guidance that NICE has already published on safe staffing levels in adult acute wards and in maternity settings was widely welcomed and will continue to be used.
“The announcement by Simon Stevens of a review of the approach to setting safe staffing levels means that the work to secure safe levels of staffing in A&E departments and in mental health and community settings is likely now to be taken forward as part of NHS England’s wider programme of work to help the NHS deal with the challenges it is facing over the next few years.
“NICE stands ready to support this work using the experience we have gained over the last two years.”have gained over the last two years.”
- Department of Health and Social Care (DHSC)
- Francis report - recommendations
- Government/DH policy
- MID STAFFORDSHIRE NHS FOUNDATION TRUST
- Mid Staffs Inquiry
- National Institute for Health and Care Excellence (NICE)
- NHS England (Commissioning Board)
- Patient safety
- Robert Francis QC
- West Midlands