'No evidence' for mandated safe staffing ratios, says draft guidance

New guidance on achieving safe staffing for adult inpatient wards in acute hospitals in England has stopped short of recommending a minimum number of nurses who should be on duty per shift.

New draft guidance on safe staffing for adult inpatient wards in acute hospitals in England emphasises no single nursing staff-to-patient ratio can be applied across all wards of the same type.

Susan Osborne
Susan Osborne says new draft guidance will
not replace already-issued programmes
Picture: Barney Newman

This reinforces previous guidance from the National Institute for Health and Care Excellence (NICE) which did not recommend a minimum number of nurses who should be on duty per shift.

The new ‘improvement resource for safe, sustainable and productive staffing’ is the first significant document from NHS Improvement (NHSI), which took over the safe staffing work last year from NICE.

The authors state: 'While NICE guidance identified evidence of 'increased risk of harm associated with a registered nurse caring for more than eight patients during the day shifts’, [it] clearly stated there is "no single nursing staff-to-patient ratio that can be applied across all acute adult inpatient wards."

'We have found no new evidence to inform a change to this statement.'

Missed opportunity

Safe Staffing Alliance chair Susan Osborne said: ‘It is such a shame NHSI are resisting mandated staffing ratios when in places like America there is strong evidence they improve patient outcomes.

‘This guidance just means we will continue to have serious variation of staffing up and down the country as trusts attempt on an individual basis to interpret what safe staffing actually means.’

Ms Osborne also drew attention to a statement on NHS England’s website, which states its safe staffing programme 'will not in any way replace or change the NICE guidance which has already been issued.

‘Yes it may be endorsing and reinforcing most of what NICE already said, but it is obviously going to replace that earlier guidance – despite what was claimed' she added.

‘It is very concerning this is being sent out just before Christmas, it’s not exactly the best time to ensure widespread attention.'

Ms Osborne also expressed concerns at the ‘over-reliance’ in the guidance on ‘multi-professional working’ through using allied health professionals (AHPs) – such as occupational therapists – to replicate the work of nurses.

The work of AHPs alongside nurses is covered by the so-called Care Hours Per Patient Day metric, which is included in the guidance after being recommended by the Lord Carter review into hospital efficiency.

Professional judgement needed

A NHSI spokesperson said it had published the consultation ‘as soon as it was able to’ and insisted ‘it had said all along it would look at’ adult inpatient wards.

‘We are saying that the evidence is clear this is not a "target" staffing level for all circumstances and therefore should be triangulated with local assessments and professional judgement to determine what is required.’

NHSI executive director of nursing Ruth May said: ‘We have done so much in the last few years to better understand the evidence to support our decision making to ensure we get the right staff, in the right place at the right time.

‘However, we need the wider system, profession and public to help refine these and the engagement phase is critical.’

The consultation runs until February 3 and can be viewed on the NHS Improvement website

You can read the draft guidance here

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