Follow NICE safe staffing guidance, says regulator

New advice for trusts on staffing their maternity services, published by the regulator today, says guidelines from the National Institute for Health and Care Excellence, published in 2015, should be followed and was “based on the best available evidence”.

The new maternity staffing advice from NHS Improvement is one of seven pieces being developed by NHSI. It was asked to produce guidance in 2015 when the Department of Health and NHS England decided to suspend NICE’s own work on it.

NICE’s programme, which cost more than £1m, had been a key recommendation of Sir Robert Francis QC following the public inquiry into poor care at the Mid Staffordshire Foundation Trust.

The decision to suspend NICE’s work sparked widespread criticism of the government and NHS England leading to health secretary Jeremy Hunt asking NHS Improvement to take the lead.

The latest document from NHS Improvement tells NHS Providers: “You should follow NICE guideline NG4 (2015) for midwives. This guideline makes recommendations on safe midwifery staffing requirements for maternity settings, based on the best available evidence.”

NICE’s recommendations included actions for trust boards, senior managers, commissioners and senior midwives in charge of departments and shifts.

NHS Improvement says responsible managers should “take NICE’s guidance fully into account”, although it states this should not override professional judgement and data on outcomes.

The document refers to the need to have a multidisciplinary maternity workforce and says support workers have a role to play but that the “key principle” is to “use them to complement rather than substitute for midwives”.

The Royal College of Obstetricians and Gynaecologists said in the absence of clear evidence on medical staffing in maternity, labour wards should have a consultant presence for a minimum of eight hours a day, seven days a week.

A duty anaesthetist should be immediately available for the labour ward 24 hours a day, with consultant support also available 24 hours a day. In busier units with more than 5,000 births, two duty anaesthetists should be available 24 hours a day in addition to a supervising consultant.

The maternity guidance reiterates previous advice to trusts that staffing levels should be reviewed at least once every six month using “systematic evidence-based workforce planning tools to assess the total multiprofessional staffing requirements (number and skill mix) for their maternity services.”

The NHS Improvement guidance says: “NHS provider boards are accountable for ensuring their organisation has the right culture, leadership and skills for safe, sustainable and productive staffing. They hold individual and collective responsibility for making judgements about staffing and the delivery of safe, effective, compassionate and responsive care within available resources.

It added: “The current climate is challenging in many ways. Increasing acuity of births and the lack of availability of maternity staff reported by the Royal Colleges are significant issues for many units.

“Maternity leaders recognise that modernising maternity services will require new ways of working to support midwives and obstetricians, anaesthetists and neonatologists, as well as ensuring that staffing numbers are adequate and appropriate.

“Commissioners, providers and higher education institutions need to work together in designing and redesigning the current and future workforce.”

An appendix to the guide also includes a list of key maternity staffing indicators that trusts should use to collect data to inform their staffing reviews and judgements.

These include patient experience measures and staff reported data such as missed breaks, overtime working, sickness and staff morale.