Exclusive: Official staffing guidance to order 'urgent' nurse staffing reviews

HSJ has obtained a draft version of new National Quality Board guidance on setting safe staffing levels which will form a major part of the government’s full response to the Francis report, which is expected to be published on Tuesday.

It sets out a series of expectations which hospital boards must comply with, which were revealed by HSJ last week, and says those organisations not meeting them must take action “as a matter of urgency”.

The National Quality Board is a committee hosted by the Department of Health, and includes representatives from all national health oversight bodies.

The “confidential draft” seen by HSJ says provider boards must receive monthly workforce information including ward-level data on staffing alongside quality information including serious incidents, healthcare acquired infections and patient experience.

Boards should also review staffing establishment at least twice a year, the guidance says. When doing so they must take into account staff responsibilities other than direct care, such as mentoring and supervising trainee and newly qualified nurses, staff training and planned and unplanned leave.

Establishments should also allow for a “realistic assessment” of the amount of time ward managers spend supervising others. This falls short of Robert Francis QC’s recommendation that all ward managers should be considered “supernumerary”, and not counted in nursing numbers.

The guidance says nursing directors should “ensure there is an uplift in planned establishments to allow for planned and unplanned leave and ensure absence is managed effectively”.

The document says many of its recommendations are already considered best practice, but that some organisations are not meeting them.

It is therefore highly likely to mean trusts need to increase nurse staffing, sparking concern about the cost, and where they will be recruited from. A recent investigation by HSJ’s sister title Nursing Times found more than a third of trusts have recruited nurses from abroad in the past year.

The tenth expectation in the National Quality Board guidance says commissioners must also play a role, by assuring themselves providers have sufficient nursing capacity.

The document says NHS England will incorporate “relevant elements” of the expectations in next year’s NHS Standard Contract.

The guidance also emphasises the importance of ensuring staffing is safe on a “shift-to-shift” basis, ensuring any temporary vacancies are filled. This follows the finding of the Keogh mortality review that organisation-level staffing data often did not reflect the reality on the wards.

Wards will be expected to display information about the nursing and other care staff present on shift. However, they will not be required to display how many staff should be on the shift as recently recommended by the Commons health committee.

It says: “Where this is the case, we expect boards to identify as a matter of urgency the actions that could be taken to meet these expectations.”

The draft of the guidance makes it clear it will not specify a minimum staffing level or ratios of registered nurses to healthcare assistants.

Notes for the foreword by chief nursing officer for England Jane Cummings, say the guidance “doesn’t prescribe numbers or ratios [as] there may never be a right number”. 

It comes amid an increasingly tense debate among senior figures about nurse staffing. The Prime Minister’s Nursing and Care Quality Forum has today called for the introduction of a minimum staffing level.