A senior figure at the National Institute for Health and Care Excellence has suggested NHS England scrapped its work on safe staffing guidance because it ‘didn’t like the answer to the question’.

  • NICE clinical director indicates NHS England “didn’t like answer” on safe staffing
  • However, he said the guidance NICE was producing “probably shouldn’t have any traction”

The comments by Mark Baker, director of the centre for clinical practice at NICE, at the Patient Safety Congress in Birmingham yesterday, have come after a decision by NHS England chief executive Simon Stevens last month to suspend NICE’s work on safe nurse staffing levels. The work had been a recommendation of the Francis report into failures at Stafford Hospital.

Mark Baker

Mark Baker said the NHS ‘has survived for most of its history by taking risks and not getting found out’

The decision has provoked widespread criticism from nursing unions and nursing workforce experts. NICE guidance on accident and emergency nurse staffing has been completed but is now not expected to be published.

Professor Baker said NICE was not going to carry on its work on safe staffing independently of NHS England. He said: “We’re not going to do that because the body that commissions it said they don’t want it.

“I think the reason they don’t want it is if you don’t like the answer to the question, you don’t ask the question. In a way the underlying problem is that the NHS has survived for most of its history by taking risks and not getting found out.

“If you eliminate the chance of being found out it then it becomes an unmanageable system.”

However, Professor Baker, a former chief executive of Bradford Teaching Hospitals Foundation Trust, also said that specific staffing levels guidance “may well work for general acute wards”. He raised serious concerns over extending it to other areas and suggested Sir Robert Francis had been wrong to limit the scope of his recommendation for guidance to qualified nurses.

He said: “So we were asked the wrong question in the first place. Robert Francis probably made the wrong recommendation certainly about restricting the staffing to nursing.”

He added that, having been told to stop, NICE was “quite relieved not to have to produce guidance which had no traction within NICE and probably shouldn’t have any in the NHS”.

Professor Baker added: “There are guidance issues about staffing which do need to be addressed but they are clearly not going to be in the immediate future.”

NHS England has said it will continue work on developing safe staffing levels in the NHS and will continue to commission evidence and produce advice for providers but that work needed to include other roles alongside nurses.

A NICE spokeswoman, in a statement after the session, said: “Our clinical practice director… was asked if NICE would be continuing its work on safe staffing. He told the audience that NICE will no longer develop guidelines in this area. However, 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.

“NHS England now has to decide how best to review the approach to setting safe staffing levels and whether or not to take forward the work that NICE has already done for accident end emergency departments and mental health and community settings. This review will form part of its wider programme of work to help the NHS deal with the challenges it is facing over the next few years. It is no easy task to develop guidelines on the safe staffing of hospital wards and other healthcare services due to a lack of evidence in this area, but we stand ready to support NHS England’s work using the experience we have gained over the last two years.”

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