Lord Carter is looking to establish ‘clearer guidance’ on safe staffing levels as part of his review of NHS efficiency, he has told HSJ.

He said his team was working with regulators to produce a “safe range” for staffing at a speciality level, which would help provide “air cover” when trusts faced inspection.

The Labour peer and a team at the Department of Health have been working with 32 trusts to identify opportunities for savings in workforce management, medicines, estates and procurement.

In an interview, he also told HSJ:

  • The cohort of 32 trusts will receive, by the end of this week, a savings figure the DH believes it can achieve.
  • Every other acute trust will receive its savings target in the coming weeks, and there will be room for negotiation before targets are finalised.
  • His review will identify places or organisations where service reconfiguration is needed.

Last week, regulators contacted trusts to clarify “contradictory messages” around safe staffing levels, and stressed that nurse-patient ratios “should not be unthinkingly adhered to”.

Lord Carter said: “I think what people want, though, is some central air cover on things like staffing levels [and] productivity…. so that if they do take a firm line, they’re supported…

Lord Carter

Lord Carter’s review will identify places or organisations where service reconfiguration is needed

“We’re working with the Care Quality Commission, Monitor and the NHS Trust Development Authority to establish a safe range for [nursing] staff.

“Because after Mid Staffs there was a sort of rise in staffing and the system told us they would appreciate clearer guidance, but nursing professionals said, ‘We still want discretion.’

“So what we’re aiming to do, and we’ve got first moves on this, is publish a safe range so if you took a particular ward you would know you should be producing this many hours of care a day.”

In effect, the methodology would provide separate guidance for each specialty, to assure trusts their staffing was appropriate in the eyes of the CQC.

This would be a more detailed tool than the 8:1 patient to nurse ratio, which is recommended by the National Institute of Health and Care Excellence in many circumstances, Lord Carter added.

Meanwhile, he said estimates for potential savings had been sent to three trusts in his cohort of 32, and were thought to be realistic. The figures are based on the “huge variations” in clinical costs, infection rates, re-admission rates, litigation payments and device and procedure selection between organisations.

Figures will be sent to the remaining 29 this week, while all acute trusts are due to receive estimates in the next few weeks.

He said the estimated savings figures for the acute sector total £5bn, but he accepted there would be “a lot of room” for negotiation before final targets are finalised in December.

An interim report in June said £5bn could be saved by 2019-20. It is hoped there will be gradual progress towards this, starting in 2016-17. Some trusts’ potential savings for 2015-16 were already included in their cost improvement plans, so there was little scope for extra savings this year, Lord Carter said.

He said his review would identify services which were unable to produce savings due to “structural problems”, and make recommendations about where reconfigurations are needed. It is unclear when this information will be published.

Earlier this month, HSJ reported how the progress of the review had slipped against the timeline initially set out by health secretary Jeremy Hunt.

Lord Carter will produce 'clearer guidance' on nurse staffing levels