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Share your news with us – email [email protected], call +44 (0)20 8872 3144 or @NurseStandard
Chief nurse Jane Cummings’ Office NHS England
Dear Colleague, Ensuring the NHS is safely staffed
I am writing to update you on the next steps to improve the safety and quality of NHS staffing. But let me first tackle head on three misconceptions. First, nothing we are doing changes the NICE guidance already issued. We are focusing on new care areas and will not be going back on the guidance published. Second, nothing in this work programme challenges the CQC’s role to inspect and rate hospitals and providers across health and adult social care. They make their own judgements on what is or is not safe. Finally, this is not about saving money; more about using the money we have as efficiently. I would not suggest anything that would compromise patient safety. It would be against all I have repeatedly highlighted since I became CNO. But to see NICE’s work as the totality of our focus on safe staffing is to miss the point. Good quality care is influenced by a more than how many nurses are on a shift. As we develop safe staffing for those working in mental health, urgent and emergency care, learning disability and community services, there are six things that will guide us: 1. We must take into account all the staff involved, not just nurses. In urgent and emergency care, as in other care settings, we need to look at doctors, paramedics and other allied health professionals, as well as nurses. 2. Many care settings are not in a hospital and span organisational boundaries. It would be inappropriate to develop a staffing structure for one type of organisation then expect it to apply to multiple institutions and roles. 3. This is not just about filling rotas or looking only at numbers. It is also about how much time nurses spend with or supporting patients, their families and carers. 4. Just as there is no one-size-fits-all approach for these new models of care, there will be no identikit approach to the mix of staff we need. The number of staff caring for patients on an orthopaedic ward in Cornwall or Doncaster is a good guide to how safe those wards are – we are not changing the current NICE guidance in acute hospitals for this reason. But the different settings for other types of care mean there is no one right answer. 5. Underpinning these will be the work outlined in my letter of 4 June, setting out the need for career progression for non-registered staff, nurse retention and flexible working. 6. There is little research into what safe staffing looks like for other care settings. We need to find a new approach to testing what is right. We will continue to use NICE for commissioning evidence reviews where appropriate, and also bring in other independent professionals and experts to guide us. The Mental Health Taskforce has agreed to lead the work on the right balance of staff in settings treating those with mental illness. NICE has already done some excellent work on nurse staffing in urgent and emergency care. Urgent and Emergency Care Vanguards will build on this guidance, taking into account other professionals. For learning disability and community care, we will establish programmes to support the development of guidance by working with the new learning disability fast-track sites and Five Year Forward View vanguards. We also recognise the importance of safe staffing in nursing homes, which collectively have more than 200,000 beds (more than in acute hospitals) and a high turnover of nursing staff. The National Quality Board and its members will help oversee this programme, working closely with regulators, Health Education England, and the DH. At the Provider Directors of Nursing meeting we held on 9 June, it was clear that those present agreed with our approach. Yours sincerely,
Jane Cummings, Chief Nursing Officer, England
This is an edited version of Jane Cummings’s letter to directors of nursing
By Sally Gillen
@Sally_gillen
England’s chief nurse Jane Cummings has written to directors of nursing to address what she describes as ‘misconceptions’ about news that the National Institute for Health and Care Excellence is shelving its programme of work on safe nurse staffing guidelines. The announcement by NICE was greeted with dismay by nursing leaders. In a letter to the Times newspaper by organisations including the RCN, the Council of Deans of Health, Unison, the Patients Association and RCNi’s Nursing Standard, the move was described as a ‘damaging step back, not only for nursing but for all who use the NHS and care about its future’. ‘The need for independent evidence-based guidance on safe staffing has never been greater,’ the letter adds. Speaking to Nursing Standard, Ms Cummings said her letter of response was partly to address ‘misconceptions’ about the announcement and to set out what NHS England will do next on safe staffing. ‘There has been some noise about this on Twitter and in the Times, and it is important we calm down and people look at what we are doing and what our next steps will be,’ Ms Cummings said.
Director support
‘I do not think directors of nursing are against NHS England’s decision to look at safe staffing overall. I have met around 70 directors of nursing, ranging from big teaching hospitals to small district general hospitals, and they have been very supportive. They think it is the right thing to do to include all professional groups in safe staffing. ‘I have a good relationship with directors of nursing so people would tell me if they did not think something was right.’
NURSING STANDARD Nursing Standard 2015.29:6-7. Downloaded from journals.rcni.com by FLINDERS UNIVERSITY on 01/30/16. For personal use only.
6 june 17 :: vol 29 no 42 :: 2015
responds to safe staffing concerns BARNEY NEWMAN
‘I AM CLEAR THAT WHAT WE ARE DOING STILL FULFILS THE CRITERIA OF WHAT WAS RECOMMENDED’
nursing alone did not represent a failure to implement Sir Robert’s recommendation. ‘I am clear that what we are doing still fulfils the criteria of what was recommended. We will build on the work that NICE has already done,’ she said. RCN general secretary Peter Carter welcomed Ms Cummings’s letter, saying it offered ‘useful clarification on the future of safe staffing work’. ‘The chief nursing officer is right to highlight the importance of wider teams and the challenges of working across different settings. It is also promising to see a continued role for NICE. ‘Recognising the value of wider health team is important but this must not come at the expense of registered nurses, because the evidence shows that it is the number of registered nurses that most influences patient safety. Focusing on the wider team will not change the fact that diluting the number of nurses, especially experienced nurses, is bad for patient care.’ To read the letter in full go to tinyurl.com/p78ccuw
– Jane Cummings
NICE’s guidance for adult inpatient wards, published last summer, will continue to be used, she added. However, NICE will stop working on guidance for community, mental health and A&E nursing. Instead NHS England will look at staffing across all groups as part of its review of urgent care and mental health services.
The Department of Health commissioned NICE to produce a set of safe staffing guidelines following the recommendation by Sir Robert Francis in his 2013 report into care failings at Mid Staffs that linked poor care to chronic understaffing. Ms Cummings said the decision to review staffing across different professional groups rather than in
COMMENT
‘TO LOSE THE EXPERTISE OF NICE IS A TRAVESTY’ Safe Staffing Alliance chair Susan Osborne responds to Jane Cummings: ‘The National Institute for Health and Care Excellence was asked to follow Recommendation 23 of the Francis report into care failings at Mid Staffordshire NHS Foundation Trust. It said: “The measures formulated by NICE should not only be of clinical outcomes, but of the suitability and competence of staff, and the culture of organisations. The standard procedures and practice should include evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff
NURSING STANDARD
numbers and skill mix. This should include nursing staff on wards, as well as clinical staff. These tools should be created after appropriate input from specialties, professional organisations, and patient and public representatives, with consideration of the benefits and value for money of possible staff: patient ratios.” ‘Only two of the three completed NICE guidelines have been issued. The A&E guide was prevented from being published due to pre-election purdah, and there is a view that it was scrapped because it was too expensive. The Care Quality Commission role as a regulator
has not changed. Jane Cummings says it is a misconception that NICE has been told to stop work to save money. If money is no object, why do 50% of trusts still have unsafe staffing levels? ‘To lose the independence of NICE, which was addressing all the components in Recommendation 23 and has the capacity and expertise to undertake this type of work, is a travesty. ‘Already professionals and patients believe this is a signal for shelving the programme because the outcomes are not palatable to officials and would be too expensive.’
june 17 :: vol 29 no 42 :: 2015 7 Nursing Standard 2015.29:6-7. Downloaded from journals.rcni.com by FLINDERS UNIVERSITY on 01/30/16. For personal use only.
Share your news with us – email [email protected], call +44 (0)20 8872 3144 or @NurseStandard
Chief nurse Jane Cummings’ Office NHS England
Dear Colleague, Ensuring the NHS is safely staffed
I am writing to update you on the next steps to improve the safety and quality of NHS staffing. But let me first tackle head on three misconceptions. First, nothing we are doing changes the NICE guidance already issued. We are focusing on new care areas and will not be going back on the guidance published. Second, nothing in this work programme challenges the CQC’s role to inspect and rate hospitals and providers across health and adult social care. They make their own judgements on what is or is not safe. Finally, this is not about saving money; more about using the money we have as efficiently. I would not suggest anything that would compromise patient safety. It would be against all I have repeatedly highlighted since I became CNO. But to see NICE’s work as the totality of our focus on safe staffing is to miss the point. Good quality care is influenced by a more than how many nurses are on a shift. As we develop safe staffing for those working in mental health, urgent and emergency care, learning disability and community services, there are six things that will guide us: 1. We must take into account all the staff involved, not just nurses. In urgent and emergency care, as in other care settings, we need to look at doctors, paramedics and other allied health professionals, as well as nurses. 2. Many care settings are not in a hospital and span organisational boundaries. It would be inappropriate to develop a staffing structure for one type of organisation then expect it to apply to multiple institutions and roles. 3. This is not just about filling rotas or looking only at numbers. It is also about how much time nurses spend with or supporting patients, their families and carers. 4. Just as there is no one-size-fits-all approach for these new models of care, there will be no identikit approach to the mix of staff we need. The number of staff caring for patients on an orthopaedic ward in Cornwall or Doncaster is a good guide to how safe those wards are – we are not changing the current NICE guidance in acute hospitals for this reason. But the different settings for other types of care mean there is no one right answer. 5. Underpinning these will be the work outlined in my letter of 4 June, setting out the need for career progression for non-registered staff, nurse retention and flexible working. 6. There is little research into what safe staffing looks like for other care settings. We need to find a new approach to testing what is right. We will continue to use NICE for commissioning evidence reviews where appropriate, and also bring in other independent professionals and experts to guide us. The Mental Health Taskforce has agreed to lead the work on the right balance of staff in settings treating those with mental illness. NICE has already done some excellent work on nurse staffing in urgent and emergency care. Urgent and Emergency Care Vanguards will build on this guidance, taking into account other professionals. For learning disability and community care, we will establish programmes to support the development of guidance by working with the new learning disability fast-track sites and Five Year Forward View vanguards. We also recognise the importance of safe staffing in nursing homes, which collectively have more than 200,000 beds (more than in acute hospitals) and a high turnover of nursing staff. The National Quality Board and its members will help oversee this programme, working closely with regulators, Health Education England, and the DH. At the Provider Directors of Nursing meeting we held on 9 June, it was clear that those present agreed with our approach. Yours sincerely,
Jane Cummings, Chief Nursing Officer, England
This is an edited version of Jane Cummings’s letter to directors of nursing
By Sally Gillen
@Sally_gillen
England’s chief nurse Jane Cummings has written to directors of nursing to address what she describes as ‘misconceptions’ about news that the National Institute for Health and Care Excellence is shelving its programme of work on safe nurse staffing guidelines. The announcement by NICE was greeted with dismay by nursing leaders. In a letter to the Times newspaper by organisations including the RCN, the Council of Deans of Health, Unison, the Patients Association and RCNi’s Nursing Standard, the move was described as a ‘damaging step back, not only for nursing but for all who use the NHS and care about its future’. ‘The need for independent evidence-based guidance on safe staffing has never been greater,’ the letter adds. Speaking to Nursing Standard, Ms Cummings said her letter of response was partly to address ‘misconceptions’ about the announcement and to set out what NHS England will do next on safe staffing. ‘There has been some noise about this on Twitter and in the Times, and it is important we calm down and people look at what we are doing and what our next steps will be,’ Ms Cummings said.
Director support
‘I do not think directors of nursing are against NHS England’s decision to look at safe staffing overall. I have met around 70 directors of nursing, ranging from big teaching hospitals to small district general hospitals, and they have been very supportive. They think it is the right thing to do to include all professional groups in safe staffing. ‘I have a good relationship with directors of nursing so people would tell me if they did not think something was right.’
NURSING STANDARD Nursing Standard 2015.29:6-7. Downloaded from journals.rcni.com by FLINDERS UNIVERSITY on 01/30/16. For personal use only.
6 june 17 :: vol 29 no 42 :: 2015
responds to safe staffing concerns BARNEY NEWMAN
‘I AM CLEAR THAT WHAT WE ARE DOING STILL FULFILS THE CRITERIA OF WHAT WAS RECOMMENDED’
nursing alone did not represent a failure to implement Sir Robert’s recommendation. ‘I am clear that what we are doing still fulfils the criteria of what was recommended. We will build on the work that NICE has already done,’ she said. RCN general secretary Peter Carter welcomed Ms Cummings’s letter, saying it offered ‘useful clarification on the future of safe staffing work’. ‘The chief nursing officer is right to highlight the importance of wider teams and the challenges of working across different settings. It is also promising to see a continued role for NICE. ‘Recognising the value of wider health team is important but this must not come at the expense of registered nurses, because the evidence shows that it is the number of registered nurses that most influences patient safety. Focusing on the wider team will not change the fact that diluting the number of nurses, especially experienced nurses, is bad for patient care.’ To read the letter in full go to tinyurl.com/p78ccuw
– Jane Cummings
NICE’s guidance for adult inpatient wards, published last summer, will continue to be used, she added. However, NICE will stop working on guidance for community, mental health and A&E nursing. Instead NHS England will look at staffing across all groups as part of its review of urgent care and mental health services.
The Department of Health commissioned NICE to produce a set of safe staffing guidelines following the recommendation by Sir Robert Francis in his 2013 report into care failings at Mid Staffs that linked poor care to chronic understaffing. Ms Cummings said the decision to review staffing across different professional groups rather than in
COMMENT
‘TO LOSE THE EXPERTISE OF NICE IS A TRAVESTY’ Safe Staffing Alliance chair Susan Osborne responds to Jane Cummings: ‘The National Institute for Health and Care Excellence was asked to follow Recommendation 23 of the Francis report into care failings at Mid Staffordshire NHS Foundation Trust. It said: “The measures formulated by NICE should not only be of clinical outcomes, but of the suitability and competence of staff, and the culture of organisations. The standard procedures and practice should include evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff
NURSING STANDARD
numbers and skill mix. This should include nursing staff on wards, as well as clinical staff. These tools should be created after appropriate input from specialties, professional organisations, and patient and public representatives, with consideration of the benefits and value for money of possible staff: patient ratios.” ‘Only two of the three completed NICE guidelines have been issued. The A&E guide was prevented from being published due to pre-election purdah, and there is a view that it was scrapped because it was too expensive. The Care Quality Commission role as a regulator
has not changed. Jane Cummings says it is a misconception that NICE has been told to stop work to save money. If money is no object, why do 50% of trusts still have unsafe staffing levels? ‘To lose the independence of NICE, which was addressing all the components in Recommendation 23 and has the capacity and expertise to undertake this type of work, is a travesty. ‘Already professionals and patients believe this is a signal for shelving the programme because the outcomes are not palatable to officials and would be too expensive.’
june 17 :: vol 29 no 42 :: 2015 7 Nursing Standard 2015.29:6-7. Downloaded from journals.rcni.com by FLINDERS UNIVERSITY on 01/30/16. For personal use only.
