National leaders have moved to resolve ‘contradictory’ messages issued to NHS providers around safe staffing levels. They stress that nurse to patient ratios ‘should not be unthinkingly adhered to’.

  • Arm’s length bodies seek to clarify “contradictory” messages over finance and staffing
  • National officials says staffing guidance should not replace judgements of experienced frontline staff
  • Letter says providers must “get the balance right by neither understaffing nor overspending”

In a letter sent to NHS providers today, the leaders of five arm’s length bodies acknowledge the difficulties of balancing patient safety with financial concerns.

However, they say national guidance recommending a maximum of eight patients to one nurse in many situations should “not replace the judgements made by experienced professionals at the front line”.

The letter, seen by HSJ, has been sent by leaders at Monitor, the NHS Trust Development Authority, NHS England, the Care Quality Commission and the National Institute for Health and Care Excellence.

They recommend a flexible approach to staffing in which allied health professionals, such as physiotherapists and pharmacists, are included in ward based teams. There should be a focus on quality of care and efficiency, rather than “just numbers and ratios of staff”.

NHS trusts are dealing with unprecedented financial difficulties this year, with the latest performance data suggesting the provider sector is heading towards a combined deficit of more than £2bn.

There had been confusion around a previous letter sent in August, which ordered trusts to revisit their financial plans for 2015-16 and advised that “vacancies are filled only where essential”.

When HSJ sought clarification on this, Monitor said the advice was only intended for non-clinical roles.

Today’s letter said: “We know that many organisations have taken a systematic and thoughtful approach to staffing wards and services safely over the past two years…. We are also aware that recent messages to the system on safe staffing and on the need to intensify efforts to meet the financial challenge have been seen as contradictory.

“The current safe staffing guidance has been designed to support decision makers at the ward/service level and at the board to get the best possible outcomes for patients within available resources.

“The guidance supports, but does not replace, the judgements made by experienced professionals at the front line. The responsibility for both safe staffing and efficiency rests, as it has always done, with provider boards.

“Trusts are responsible for ensuring that they get the balance right by neither understaffing nor overspending.”

The leaders acknowledged that staffing levels are routinely assessed by the CQC, but said: “These assessments (also) include observation of care delivery, listening to staff and patients, assessing outcomes of care and discussions with nurse managers about assessment of acuity levels and achievement of planned staffing levels. Staffing ratios are never the sole determinant of a rating.”