NHS England chief nursing officer Jane Cummings has said the National Institute for Health and Care Excellence will continue to be used for evidence reviews on safe staffing ‘where appropriate’.
In a letter to nursing directors today, Ms Cummings also said suspending work on safe nurse staffing levels in the NHS was not about saving money and stressed she would not “compromise patient safety”.
Her letter follows mounting criticism of the decision last week by NHS England chief executive Simon Stevens to suspend the work.
The programme was a key recommendation of the Francis inquiry and was accepted by the last government, which asked NICE to look at staffing levels across nine healthcare settings.
Ms Cummings said the work on staffing that NHS England would take forward would not go back on work already carried out by NICE. She also reiterated the ability of the Care Quality Commission to form its own judgements on safe staffing levels when it inspects trusts.
She said: “This is not about saving money; more about using the money we have as efficiently and effectively as possible. I would not suggest anything that would compromise patient safety. It would be against all I have repeatedly highlighted since I became CNO and is fundamental to our profession. It would also be a false economy – compromising safety just causes distress to patients, adds to the cost of care and a growing litigation bill.
“But to see NICE’s work as the totality of our focus on safe staffing is to miss the point. The ultimate outcome of good quality care is influenced by a far greater range of issues than how many nurses are on any particular shift, even though that is important.”
Ms Cummings set out six reasons why a different approach was needed. These included:
- ensuring other staff groups were considered;
- different care settings;
- contact time nurses have with patients; and
- new models of care.
She also highlighted the need to consider career progression for non-registered nursing staff and the development of new roles, plus the fact there was little research on staffing levels in non-hospital care settings.
“We will continue to use NICE for commissioning evidence reviews where appropriate and also bring in other independent professionals and experts to guide us,” she said.
Existing reviews in mental health and emergency care will take forward work, with new programmes developed for learning disability and community services.
“I will confirm the governance and organisational arrangements in the next few weeks, ensuring that key stakeholders are involved,” Ms Cummings said.
Earlier this week a member of NICE’s advisory committee on safe staffing warned many trusts would have been exposed for “inadequate staffing” had guidance on emergency departments been published.
James Bird, a matron for the emergency department at Imperial College Healthcare Trust, who was working with NICE on the A&E guidance, said he feared a “looser” version of the guidance would be produced by NHS England.
He said the A&E guidelines would have meant “there would be a number of trusts that would have realised that they were inadequately staffed”.
“Abandoning the guidance does not mean they are not inadequately staffed,” Mr Bird added. “What we have now is that there is no guideline for them to go against, so something slightly looser might come out.
“Something will have to come out [from NHS England] but whether it will be as robust [as NICE] and will contain the same bits remains to be seen.”
He added that the NICE guideline “was not going to be a cheap guideline to meet”.
He said any future guidance from NHS England, which he expected “reasonably soon”, would be less thorough than NICE’s work because the national commissioning body “hasn’t got the resources”.