• Nursing directors to develop new tools and safeguards around workforce reforms
  • NHS Improvement wants to ensure trusts follow proper governance processes

Two nursing directors have been asked by NHS Improvement to lead work developing new safeguards to protect care quality when trusts make significant changes to their workforce.

A letter from chief nurse Ruth May to nursing directors, medical directors and human resources directors, sent last week, set out NHSI’s expectations on trusts in terms of how they should safely pursue workforce reforms, including implementing safe staffing guidance.

The letter said Helen Blanchard, director of nursing at Royal United Hospitals Bath Foundation Trust and Suzanne Banks, director of nursing at Sherwood Forest FT, have been asked to lead work developing safeguards and new tools for providers.

This will be completed by the summer and follows NHSI chief executive Jim Mackey saying the regulator wanted to “kick the tyres” on workforce reform to ensure safety.

In an interview with HSJ in December, Mr Mackey said NHSI would intervene where trusts were making questionable reforms.

“There needs to be a kind of safety [check] on let’s not cross any de minimus standards. I am the accounting officer for NHS trusts, I am responsible for the safety in a lot of these places.

“I want some basic assurance and I want to see evidence that what they are planning to do at the end of it is better than what they are doing now. We should be kicking the tyres – that is part of our job,” he said.

The letter from Ms May does not describe specific safeguards, but HSJ understands NHSI will be looking to ensure a governance process is in place locally and nationally with trusts needing to demonstrate they have carried out proper risk assessments and have safeguards in place to protect care quality. NHSI will want to be assured there is no “inappropriate substitution” of some roles.

This could include a focus on the use of nursing associates and the potential substitution of registered nurses as well as physician assistants, advanced nurse practitioners and non-clinical administration roles in wards.

Ms May’s letter said workforce challenges were a “shared concern” between NHSI, NHS England and Health Education England with “supply, retention, planning, agency/locum controls and operational day to day staffing issues” being focus areas.

The letter referred directors of nursing and medical directors to recently published safe staffing guidance and expectations of how this should be implemented. It said feedback from providers had highlighted a need for “some detailed implementation tools and workforce safeguards to ensure quality outcomes for patients”.

A final set of tools will be developed by the summer, with a workshop next week looking at regulation and support approaches, delivering solutions safely, and operational and quality outcomes.

NHSI has also set up a “safe staffing improvement team” led by senior clinical staff “to support the implementation of evidence based tools and approaches for organisations that require support”. The team has been providing onsite support to trusts.

In recent months, concern has grown that some clinical roles such as registered nurses could be replaced with cheaper staff. Some sustainability and transformation plans refer to using generic support staff in place of nurses despite evidence linking substitution with increased safety risks.