NHS providers may have to increase the number of nurses in emergency departments after regulators and the Department of Health suggested trusts need to consider new safe staffing evidence from the National Institute for Health and Care Excellence.

  • National regulators will consider new NICE guidance and expect trusts to consider all available evidence
  • DH says trusts will continue to use NICE guidance
  • Pressure on providers comes amid a national shortage of nurses

HSJ revealed on Friday that NICE plans to make public its completed work on accident and emergency safe staffing, despite having been directed to suspend the programme by NHS England last month.

The Care Quality Commission has told HSJ it will look closely at NICE’s work and consider how to incorporate it into its inspection regime.

Monitor and the NHS Trust Development Authority both said they expect trusts to use all available evidence when deciding on staffing levels.

The DH – which commissioned NICE with NHS England to develop the guidance in response to the 2013 Francis report – said trusts should consider the NICE recommendations while NHS England continues to develop its own approach.

Although the work to be published by NICE, due later this month, will not be official guidance, it will be the best assessment of staffing levels and impact on patient outcomes in A&E available to NHS providers.

Pressure to act on the findings may exacerbate the difficulty providers face in recruiting more nurses during a nation-wide shortage. Health Education England said in-year demand for nurses increased by 21,000 last year – more than the total annual output of every nursing school in England – following the Francis report.

A draft of the NICE A&E guidance, published in January for consultation, recommended a number of nurse to patient ratios in emergency departments across different situations.

A CQC spokesman told HSJ: “We will look carefully at the guidance coming from either NICE or NHS England. We will then decide how best to incorporate this into our inspection methodology.”

He said that as the independent regulator of standards, the CQC would assess staffing levels during all inspections by observing care, talking to patients, examining staff numbers, and looking at incident reports and other data. “Our judgements about staffing are never based solely on numbers,” he added.

A TDA spokesman said: “We expect all trust boards to look at the evidence available when making decisions about staffing levels across the full range of services they provide. Any new work in this area will add to the range of information and tools already available to support trusts in making their judgements.”

A spokesman for foundation trust regulator Monitor, which is expected to take on new responsibilities for quality improvement and patient safety, told HSJ: “We would expect foundation trusts to use all available evidence, including local data and nationally produced guidelines, to ensure they are providing safe staffing levels and the best care for patients in all departments, including A&E.”

The DH initially referred questions on how trusts should respond to the NICE publication to NHS England, but when pressed said it expected them to consider what was published.

A department spokeswoman said: “We remain committed to supporting NHS trusts to use their resources as effectively as possible for patients, including the critical priority that staffing levels are safe.

“NICE guidance will continue to be used by NHS trusts to help them look at their approach to staffing and decide what is best for patients. NHS England will take this work forward.”

NHS England asked NICE to suspend its work on safe nurse staffing last month, drawing criticism from Sir Robert Francis, nursing unions and workforce experts.

NHS England has argued it is best placed to take the work forward as part of ongoing service reviews into emergency care and mental health, which would consider other staff groups such as allied health professionals. The organisation was asked to respond on Friday, but did not comment in time for our deadline.