Independent work on safer ratios of nurses to patients across the NHS, was a key recommendation of the Francis inquiry into failings at Stafford hospital. This week, the government quietly shut that work down.
In a shock move, the government has abandoned its key project to ensure hospitals have enough nurses to look after patients safely. The move comes in response to a speech yesterday by NHS England boss Simon Stevens, who told a conference of NHS leaders in Liverpool that he wanted to move away from the “more mechanistic approach to the setting of nurse staffing ratios”.
In response the clinical advisor NICE moved swiftly, with NICE chief executive Sir Andrew Dillon saying “I have taken the decision to suspend further work on our safe staffing programme, including any further meetings of the advisory committee.”
Setting safe staffing levels will now be carried out by Chief Nursing Officer Jane Cummings, as part of NHS England reviews of urgent and emergency care and mental health services. While it might seem sensible for the Chief Nurse to set safe staffing levels, this removes the process from the independent, clinical and evidence-based oversight of NICE and puts it firmly in the hands of a loyal government institution.
The work on the NICE staffing guidance was the long awaited outcome of the Francis report into failings of care at Mid Staffordshire Hospital. One of the key recommendations from Sir Robert Francis was that NICE should draw up “evidence based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix”.
Julie Bailey of Cure The NHS, whose mother died in Mid-Staffordshire hospital, yesterday called the government’s abandonment of this work, “a betrayal of all we fought for”, adding “safe staffing is critical for patient safety. This is a huge step backwards for us all”.
Many campaigners had hoped that the Department of Health would implement some form of mandatory staffing levels last year, due to the public pressure generated by the Francis report. Jane Ball, at the time Deputy Director of the National Nursing Research Unit, pointed out that “the Francis inquiry tells us inadequate staffing costs lives.”
Hunt’s response was merely to promise that NICE would produce independent evidence-based guidance on safe staffing.
But that independence has now gone. Former Chief Nursing Officer Dame Christine Beasley has already opposed mandatory staffing ratios in her evidence to the Francis Inquiry in case they became the “ceiling not the floor”.
NICE’s work had already been subject to many delays. But it had eventually produced several documents outlining an evidence based staffing policy for different parts of the NHS; acute wards and maternity units. NICE had recommended set ratios in their guidance for A&Es, and although not mandatory and not binding, these recommendations would have been small but significant improvements in staffing levels.
If this work had continued it could have given nurses and campaigners a key tool with which to demand improved staffing levels across NHS services.
The decision to suspend this work - rendering useless the guidance documents still in development - represents a rolling back of the minor recommendations made by NICE, and a complete abandonment of a key plank of its promise to ensure Mid-Staffs never happened again.
Now cash-strapped hospital trust management will retain total control over staffing levels in their hospitals. There also won't be national guidance which could be used to hold private healthcare providers to account when they take over NHS services and cut staff.
The move is a slap in the face for patient safety campaigners, particularly those around the Mid Staffs Inquiry who had hoped the government would eventually improve staffing levels to prevent further poor care and abuses.
For nurses it’s another sign of the impending attack. With this week’s announcement of restrictions on the agency nurse budget, it’s evident the government will be looking to cut staffing budgets to save money. With the government looking for another £22 billion in “efficiency savings” and refusing to rule out staff cuts, dumping the staff ratio guidance means there are less policy obstacles to the cost-cutting measures which are to come.
This announcement has already caused fury on social media, but that outrage has to translate into action. RCN, UNISON & UNITE need to issue strong statements against this move, but more importantly, they need to mobilise their members to fight for mandatory minimum staffing levels.
Unions have produced numerous reports about safe staffing levels, and each one has found mandatory minimums are massively popular with nursing staff, receiving 80-90% support in survey after survey. But no union had established an active campaign among its members to fight for them.
This has to change. It must be obvious now that the government has no intention of introducing reforms which will impede its ‘austerity’ package or prevent private sector profiteering in the NHS. It is only a social movement of NHS workers and patients pressuring the government which will be able to deliver these important protective measures for our NHS.
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