Plans to publish safe nurse staffing guidance for emergency departments have been abandoned in a U-turn by the National Institute for Health and Care Excellence.

  • NICE abandons plan to publish safe staffing guidance itself
  • Source claims NICE came under pressure to make U-turn
  • DH calls allegation “nonsense”
  • NHS Improvement will release the work later this year

NICE had previously said it would publish its finished work on safe nurse staffing levels in accident and emergency on its website this month, along with four evidence reviews of safe staffing in other settings such as mental health and community nursing.

However, it has now said it will not make the information available to avoid pre-empting future work on safe staffing by new regulator NHS Improvement.

One source in NICE told HSJ it had come under “pressure” from both NHS England and the Department of Health not to publish the information on its website because of fears it would become de facto official guidance that NHS trusts would feel under pressure to follow.

The source said: “[NHS England and the DH] are trying to stop it coming out in that form. They wanted to control the information.”

However, in a statement to HSJ the DH said the claim was “nonsense”. It added: “Existing draft work on safe staffing will be published by NHS Improvement as part of a package of supporting evidence for new guidance. What’s more, NICE will be involved in the final approval process for future safe staffing guidance.”

On Monday HSJ was told that NICE was planning to make the A&E work available to any member of the public who requested it from today. This changed last night when HSJ was told the information will remain unpublished and unavailable until NHS Improvement releases it later this year.

Sir Andrew Dillon

It is important that NICE does not ‘pre-empt the work by NHS Improvement’, Sir Andrew Dillon said

Eddie Jones, head of the clinical negligence department at JMW Solicitors, said the decision by NICE not to issue its safe staffing guidelines was now “a matter of concern”.

He said: “Having previously made clear its intention to publish this information, it would appear to have come under pressure not to do so… My concern is whether this is an indication of how NICE is to be treated by this government.”

Sarah Wollaston, chair of the Commons health committee, said she would be concerned if NICE had been put under pressure. She said: “I see no reason why [NICE’s work] can’t come with caveats. I think there is an over-controlling sentiment sometimes with work that has been commissioned with public money. Clearly it was ready to go and NICE was ready to publish and I think they should publish.

“It is very important that where bodies are supposed to be independent they are allowed to behave in an independent manner.”

President of the Royal College of Emergency Medicine Clifford Mann said he believed not publishing the information this month was a “retrograde step” which “will allow unacceptable variation in staff to patient ratios to continue and will inevitably have consequences for patient care”.

He added: “I think it is difficult to justify why a process that is as methodologically sound as the NICE process can’t be shared with the wider public.”

There has been widespread criticism of the government and NHS England after the latter directed NICE to suspend its work on safe staffing – a key recommendation of the Francis report.

Earlier this month, health secretary Jeremy Hunt intervened in the row and said work on safe staffing levels would be taken forward by NHS Improvement, with NICE being one of the reviewers of its proposals.

NICE chief executive Sir Andrew Dillon told HSJ it was important NICE did not “pre-empt the outcome of the work to be done by NHS Improvement and NHS England by publishing our conclusions at this stage”.

He added: “We do understand and welcome the public interest in our review of the evidence on safe staffing. With this in mind, the DH have confirmed that NHS Improvement will publish our final recommendations later this year, as part of the evidence base for the safe staffing guidelines they are developing. NICE stands ready to support this work using the experience we have gained over the last two years.”

A spokesman for NHS England said it had “categorically not asked NICE to withhold publication of the A&E material.”

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