• NHS Improvement says safe staffing guidance will be evidence based
  • Ruth May says she will intervene to support directors of nursing in decisions
  • Work follows the suspension of safe nurse staffing work by NICE in 2015

NHS Improvement’s chief nurse will intervene to back nursing directors where they are pressured to make bad decisions about staffing, she has told HSJ.

Ruth May also insisted forthcoming guidance on safe staffing from her organisation would be based on the latest evidence and research.

She revealed in an exclusive interview with HSJ that NHS Improvement’s first three staffing guidance documents would be published for consultation next month. They will cover inpatient, mental health and learning disability services.

Work on the remaining settings – emergency, maternity, community and children’s services – will be published for consultation early in the new year, and all the guidance will be finalised by early summer, Ms May revealed.

Ms May said the Care Quality Commission would sign off on the guidance – to be described as “resource guides” – and would inspect providers against it. She said: “It is incumbent on the trust to have quite clear systems and processes to determine what is safe and effective and sustainable staffing.

“That is very clear in the expectations… It’s right that I keep making sure directors of nursing are able to make decisions based on the evidence in front of them, and I will work to support them to do that and sometimes that will mean me intervening to support the director of nursing in a much more proactive way. I will definitely be prepared to do that.”

NHS Improvement took over the role of developing guidance on safe staffing levels last year, after the Department of Health suspended work being done by the National Institute for Health and Care Excellence.

The NICE work was a response to a Francis inquiry report recommendation, and after it was cancelled some expressed concerns that NHS Improvement’s guidance would not be properly based on evidence about staffing.

Ms May said the regulator had ensured there were relevant experts on each of its committees which are overseeing the work, and that they had been commissioned to carry out evidence reviews.

Ms May told HSJ: “We are not going to ignore any evidence. Time has moved on since Francis did his report.

“More evidence is available to us and we must make sure we use that evidence in our considerations. I genuinely believe this will be an evidence based process, we have got the academics in there with us and they certainly tell us their views.”

NHS Improvement’s guidance is expected to discuss staff groups beyond registered nurses, though its exact extent is not yet known.

Asked about whether the new guidance would include minimum staffing ratios, as was recommended by NICE in leaked guidance for emergency departments, Ms May declined to say but that this had not been barred.

“It will either land well with directors of nursing and frontline staff alike or not,” she said. “It is important to measure inputs but not inputs alone. I believe if you measure inputs and outcomes you will get the right skill mix and numbers of staff that you require.”

NHS Improvement told HSJ the evidence reviews commissioned by the committees would be published alongside the new guides along with measurement tools.