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Voices - We cannot leave safe staffing to be set locally, insists Susan Osborne

Earlier this month, questions were asked in the House of Lords about why NHS England suspended work on safe staffing guidance being carried out by the National Institute for Health and Care Excellence. Within a couple of weeks of suspending NICE’s work, NHS England published its own guidance on mental health staffing, which was criticised by nurses for its lack of detail on staffing levels and skill mix.

Based on little evidence – a pilot of six trusts – there was no indication in the guidance about what constitutes a safe staffing level, only that it should be locally determined.

But it is notoriously difficult to achieve safe staffing if you use this approach. It reinforces the idea of staffing levels being set in accordance with budgets, rather than quality of service and patient safety.

Despite being asked by NHS England to drop the work, NICE has subsequently pressed on. Its recommendations for nurse staffing levels in A&E departments, which include mandated levels, are due to be published imminently.

Is this a signal from NICE of the need for nationally determined staffing levels, and recognition that local determination does not work? NICE will also carry out a review of any safe staffing guidance developed by NHS England.

Ensuring NICE is involved in guidance, along with the House of Lords intervention, makes it clear safe staffing will continue to be high on the NHS agenda, and that professionals will be supported to fight moves that put finances above patient safety.

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