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Concerns for Patient Safety as NICE Abandons NHS Staffing Guidelines

The National Institute for Health and Care Excellence (NICE) has announced that it will cease drafting guidelines on NHS staffing levels and will instead pass responsibility onto NHS England at the latter’s request.

NHS staffing level guidelines were commended by Sir Robert Francis QC in his 2013 report following the investigation into the Mid Staffordshire NHS Foundation Trust in 2008. The investigation found that appalling conditions and inadequacies at Stafford Hospital had led to the deaths of hundreds of patients.

In the wake of the scandal, Sir Francis chaired a public inquiry into the Trust, investigating how and why it had failed patients. The report revealed there had been systemic failures within the Trust, notably, too much tolerance of poor standards and a culture focused not on patients and their care, but on “doing the system’s business”.

The report made 290 recommendations designed to ensure that patients’ interests were put first and a more positive culture was promoted. The report noted that understaffing had significantly contributed to the scandal and therefore recommended NICE compile guidelines on NHS-wide staffing levels to address the problem.

However, NICE has now unexpectedly announced that the task of devising ratios regarding necessary staffing levels will be transferred to NHS England.

While NICE is an independent watchdog that provides national guidance and advice to improve health and social care, NHS England is a public body forming part of the Department of Health, whose role is to oversee the budget, planning, delivery and day-to-day operation of the NHS in England. There is therefore concern that NHS England will place budgetary pressures above patient safety and that this may lead to the introduction of lower standards when it comes to staffing levels. More worryingly, is the fear that it may, in fact, scrap these guidelines altogether.

Sir Robert Francis QC commented on the news, telling the Health Service Journal that he is “surprised and concerned” by the news. Francis added that whilst he does not object to NHS England reviewing staffing levels, he had made a specific recommendation that it should be NICE who draft the guidelines, owing to their analytical approach and, of course, their independence from the government.

NHS England must make £22bn of efficiency savings and there are concerns it will try to meet this target by cutting staff. Supporters of the “Cure The NHS” campaign group, which was formed in 2007 following the death of the founder’s mother at Stafford Hospital, have stated that they “fought too hard for the Francis report,” and that they “must ensure that Francis’ recommendations matter and are implemented to ensure it never happens again”.

Fears that the NHS may not have learned from its past mistakes were echoed by Dr Peter Carter, chief executive of the Royal College of Nursing, who commented that, “We must not repeat mistakes of the past, where staffing levels were cut, and patients suffered as a result.”

Stephen Jones, National Practice Development Leader for Clinical Negligence at Slater and Gordon UK said: “The Francis Inquiry looked at the issues which led to the Mid Staffordshire scandal in great detail. It seems strange that one of its fundamental recommendations should be potentially diluted in this way and we will have to see what long term consequences this brings.”

Indeed, the key aim of the Francis report was to improve standards, reduce negligence, and ensure that a culture is fostered where patients’ wellbeing comes first and care providers are held accountable for the service they provide. NHS England must not lose sight of the aims of the report and its recommendations by once again placing budgetary concerns above the safety of those it cares for, or it will be patients who suffer.

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