Recommendation 23

Formulation of standard procedures and practice

Accepted
The measures formulated by the National Institute for Health and Clinical Excellence should include measures not only of clinical outcomes, but of the suitability and competence of staff, and the culture of organisations. The standard procedures and practice should include evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix. This should include nursing staff on wards, as well as clinical staff. These tools should be created after appropriate input from specialities, professional organisations, and patient and public representatives, and consideration of the benefits and value for money of possible staff:patient ratios.

The Department of Health have therefore tasked the National Institute for Health and Care Excellence to set out authoritative, evidence-based guidance on safe staffing.  By summer 2014, the National Institute for Health and Care Excellence will have produced guidance on safe staffing in acute settings, including its view of existing staffing tools. This initial phase will be followed by further work to develop full accreditation of staffing tools against the evidence-based guidance, and work on safe staffing in non-acute settings, including mental health, community services and learning disability.  The focus of the work will be nursing and maternity staffing levels, but it will also take into account the importance of getting skill mix right and the wider context of other workforce groups, along with the importance of multi-disciplinary working in modern healthcare.

The work led by the National Institute for Health and Care Excellence will be driven by an independent advisory committee for staffing.  This will consider the evidence and draft the guidance, but it will also be able to signal the need for changes to existing tools where the evidence clearly indicates that there is an urgent need for them to be updated.

Ahead of the work being undertaken by the National Institute for Health and Care Excellence, the National Quality Board is publishing alongside this response a guidance document that sets out the current evidence on safe staffing and makes clear the immediate expectations on all NHS bodies what they must do to ensure that every ward and every shift has the staff needed to ensure that patients receive safe care.

NHS Trusts should therefore, 19th November 2013, take account of the guidance issued by the National Quality Board.  They should follow this advice until guidance developed by the National Institute for Health and Care Excellence advisory committee for staffing is rolled-out from summer 2014.

The guidance issued by the National Institute for Health and Care Excellence is not expected to include absolute staffing ratios given the inflexibility of such an approach, and the potential risks and disadvantages that the rigid application of ratios could have for patient care.  The guidance will, however, provide an evidenced, authoritative basis for staffing decisions.  The National Institute for Health and Care Excellence , NHS England, Health Education England and other national organisations will work together to ensure that NHS Trusts have the tools they need to make decisions to secure safe staffing; and these decisions will then be subject to external scrutiny and challenge by commissioners, regulators and the public, and inspection by the Chief Inspector of Hospitals.

Update

The National Quality Board staff guidance document to support providers and commissioners to make the right decisions about nursing, midwifery and care staffing capacity and capability was published in November 2013.

The National Institute for Health and Care Excellence is working over a three-year period on guidance on safe staffing in nine different settings (including acute, community, mental health, and learning disability). A consultation on the first setting, adult acute wards, ran from 12 May to 10 June 2014 and the guidance was published in July 2014. This recommends a systematic approach at ward level to ensure that patients receive the nursing care they need, regardless of the ward to which they are allocated, the time of the day, or the day of the week.

The National Institute for Health and Care Excellence have been consulting on draft guidance on safe staffing in maternity settings between October and November 2014 and they expect to publish the guidance shortly