The NHS has been accused of backtracking on improvements to patient safety brought in after the Mid Staffordshire hospital scandal in an effort to tackle its escalating financial problems.
The National Institute of Health and Clinical Excellence (Nice) watchdog has unexpectedly scrapped work to set out how many nurses are needed in different parts of hospitals to ensure safe patient care.
The move drew sharp criticism from nurses’ leaders, patient safety campaigners and Sir Robert Francis, the QC whose official report into Mid Staffs recommended Nice draw up guidelines on NHS-wide safe staffing levels, because understaffing had contributed significantly to the scandal.
Nice – which is an independent body – said it had stopped devising a raft of patient to staff ratios intended to help guarantee patient safety in A&E units and mental health settings at the request of NHS England, which will now take over the work.
However the fear is that NHS England will either introduce lower standards – in terms of the number of nurses required – that are cheaper for hospitals to meet, or that the guidelines on the safe number of nurses will be abandoned altogether.
NHS England has already sparked concern by deciding to start publishing data on hospitals’ A&E waiting times monthly instead of weekly, and to scrap two targets covering patients’ right to be treated in hospital within 18 weeks of referral by their GP.
NHS England needs to make £22bn of efficiency savings to help close the £30bn gap expected in its finances by 2020. There are growing fears that hospitals will cut staff to help meet it.
“I am surprised and concerned by this news,” Francis told the Health Service Journal. Nice, which advises ministers and the NHS on the best ways to improve healthcare, is much better-suited to devising safe staffing ratios than NHS England, he added.
While he did not object to NHS England looking into staffing levels, “I specifically recommended the work which Nice has been undertaking for a reason, namely they have an evidence-based and analytical approach which I believed would be very helpful in filling what appeared to be a gap in the discussions on this topic. Nice also has an advantage not enjoyed by NHS England of being independent.”
Francis also implicitly criticised Simon Stevens, NHS England’s chief executive, who is believed to be behind the move. “I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of Nice has been stopped.”
Dr Peter Carter, chief executive of the Royal College of Nursing, said he feared that the NHS might repeat previous mistakes by reducing numbers of staff in order to save money.
“If staffing levels are not based on evidence there is a danger they will be based on cost. We must not repeat the mistakes of the past, where staffing levels were cut to save money, and patients suffered as a result. We are concerned that this move is driven by affordability, and patients and staff must be assured that this is not the case,” he said.
Julie Bailey, whose Cure The NHS campaign group played a key role in revealing the extent of poor care at Stafford Hospital in 2005-2009, said the move was an “absolute disgrace”. She warned Jeremy Hunt, the health secretary, that “you will lose all credibility with patients, public and Cure The NHS” by backing it.
“We are so disappointed, Jeremy Hunt has championed patients and their safety. This will be a huge step backwards. We’re not prepared to go back to those dark days. We fought too hard for the Francis report and now we must ensure that his recommendations matter and are implemented to ensure it never happens again,” Bailey added.
Nice has already produced safe staffing levels for adult acute wards and maternity units, which have been a key element of the NHS’s drive since Mid Staffs to improve safety.
But NHS England will now take over its planned work on devising further ratios for emergency departments, mental health units and community health service providers.
Nice pointedly stated that “NHS England has asked Nice not to begin new activity in its safe staffing programme”. Its planned work “is likely now to be taken forward as part of NHS England’s wider programme of work to help the NHS deal with the challenges it is facing over the next few years,” said Andrew Dillon, its chief executive.
Andy Burnham, the shadow health secretary, accused Jeremy Hunt of seeking to reduce the discomfort of weekly publication, often revealing that the A&E targets had been missed, especially over the winter.
“It’s hard to see what justification there can there be for moving A&E data from weekly to monthly reports. From a government that supposedly supports transparency this looks like a cynical attempt to bury bad news,” he said.
