Recommendation 205

Recording advice from nursing directors on any major changes to nursing arrangements

Accepted in principle
Commissioning arrangements should require the boards of provider organisations to seek and record the advice of its nursing director on the impact on the quality of care and patient safety of any proposed major change to nurse staffing arrangements or provision facilities, and to record whether they accepted or rejected the advice, in the latter case recording its reasons for doing so.

Compassion in Practice, the vision and strategy for nursing in England, asks boards to sign off and publish staffing levels.  NHS England has asked that decisions on quality improvement plans are signed off by medical and nursing directors, and will consider going further to ask for their sign off on staffing changes for clinical staff as well as service provision.

The NHS Standard Contract will be strengthened to require providers to set staffing levels on the basis of evidence, monitor actual versus intended staffing levels and share this information with commissioners and the public.

The Chief Nursing Officer is providing leadership through Compassion in Practice. Key action areas include:

  •  Boards to sign off and publish evidence based staffing levels at least every 6 months, linked to quality of care and patient experience; and
  • deploying staff effectively and efficiently; identify the impact this has on quality of care and the experience of people in our care.

Update

In December 2013 NHS England published the NHS Standard Contract for 2014–15, which strengthened the requirements for providers to set staffing levels on the basis of evidence, monitoring actual versus intended staffing levels and sharing information with commissioners and the public. Providers have operated under the new provisions from 1st April 2014. The requirements are detailed within General Condition 5.2 of the Contract.