Responsibility for regulating and monitoring compliance

Accepted.
The Department of Health have therefore tasked the National Institute for Health and Care Excellence to set out authoritative, evidence-based guidance on safe staffing. By Summer 2014, the National Institute for Health and Care Excellence will have produced guidance on safe staffing in acute settings, including its view of existing staffing tools. This initial phase will be followed by further work to develop full accreditation of staffing tools against the evidence-based guidance, and work on safe staffing in non-acute settings, including mental health, community services and learning disability. The focus of the work will be nursing and maternity staffing levels, but it will also take into account the importance of getting skill mix right and the wider context of other workforce groups, along with the importance of multi- disciplinary working in modern healthcare.
The work led by the National Institute for Health and Care Excellence will be driven by an independent advisory committee for staffing. This will consider the evidence and draft the guidance, but it will also be able to signal the need for changes to existing tools where the evidence clearly indicates that there is an urgent need for them to be updated.
Ahead of the work being undertaken by the National Institute for Health and Care Excellence, the National Quality Board is publishing alongside this response a guidance document that sets out the current evidence on safe staffing and makes clear the immediate expectations on all NHS bodies what they must do to ensure that every ward and every shift has the staff needed to ensure that patients receive safe care.
NHS Trusts should therefore, from today, take account of the guidance issued by the National Quality Board. They should follow this advice until guidance developed by the National Institute for Health and Care Excellence advisory committee for staffing is rolled-out from Spring 2014.
The guidance issued by the National Institute for Health and Care Excellence is not expected to include absolute staffing ratios given the inflexibility of such an approach, and the potential risks and disadvantages that the rigid application of ratios could have for patient care. The guidance will, however, provide an evidenced, authoritative basis for staffing decisions. The National Institute for Health and Care Excellence, NHS England, Health Education England and other national organisations will work together to ensure that NHS Trusts have the tools they need to make decisions to secure safe staffing; and these decisions will then be subject to external scrutiny and challenge by commissioners, regulators and the public, and inspection by the Chief Inspector of Hospitals.

The Thirlwall Inquiry has noted action taken following the conclusion of the Mid-Staffordshire Inquiry 2013.

As the Thirlwall Inquiry has noted, NICE issued guidance on safe staffing in 2014-2015. NICE continues to issue guidance on the topics raised and recent examples include guides on creating a safeguarding culture, and positive working culture for support children and young people with complex needs.

See response to Recommendation 93 (Safe staffing).

NHS England has also published safe staffing improvement resources across a number of specific service settings. They were designed by service users and health professionals to support Trusts to make safe and sustainable staffing decisions

Medical Devices Outcomes Registry

NHS England launched the Medical Devices Outcomes Registry (MODR) in April 2024, which resides on NHS England’s Outcome Registries Platform as a single repository to collect the responsible consultant (GMC number), supervising surgeon (GMC number) and lead surgeon (GMC number) . The MDOR will support improved patient safety by enabling analysis to facilitate surveillance of High-Risk Medical Devices through linkage of component data modules, including associated patient outcomes, to support patient focussed activities such as review or recall of specific patients and devices.

The NCIP portal is a free data platform that allows consultants to review their own data: improving clinical quality, patient safety and supporting career development. It provides consultants with data covering their NHS practice wherever it is performed with high-quality, specialty-specific dashboards at patient level.

Nearly all Trusts in England have been enrolled in NCIP (99%) and over 9,000 consultants now have access to the portal following universal access given across 7 surgical specialties.

NCIP is on track to give access to every consultant in 14 surgical specialties by 1 April 2025 with the intention of expanding into non-surgical specialties subsequently. Access to the portal has also been given to Medical Directors, Responsible Officers (who have governance responsibilities) and Trust Specialty Clinical Leads.

NCIP is now established as the visualisation platform for individual consultant outcome data but for very cogent reasons is not in the public domain. However, once a single repository is established and there is confidence in the accuracy of the data, discussions will take place with the profession as to what information is appropriate for publication.

The National Quality Board staff guidance document to support providers and commissioners to make the right decisions about nursing, midwifery and care staffing capacity and capability was published in November 2013.

The National Institute for Health and Care Excellence is working over a three-year period on guidance on safe staffing in nine different settings (including acute, community, mental health, and learning disability). A consultation on the first setting, adult acute wards, ran from 12 May to 10 June 2014 and the guidance was published in July 2014. This recommends a systematic approach at ward level to ensure that patients receive the nursing care they need, regardless of the ward to which they are allocated, the time of the day, or the day of the week.

The National Institute for Health and Care Excellence have been consulting on draft guidance on safe staffing in maternity settings between October and November 2014 and they expect to publish the guidance shortly

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said that the National Institute for Health and Care Excellence was working over a 3-year period on guidance on safe staffing in nine different settings.

The National Institute for Health and Care Excellence published guidance on safe staffing levels for nursing in adult inpatient wards in acute hospitals in July 2014. Guidance on safe midwifery staffing for maternity settings was published in February 2015. In June 2015, the National Institute for Health and Care Excellence’s work on safe staffing levels was suspended.

The Government did not explicitly respond to the recommendation for measures relating to the culture of organisations.

Making sure that hospitals and community services are safely staffed remains an important priority for the NHS. The guidance that NICE has already published on safe staffing levels in adult acute wards and in maternity settings was widely welcomed and will continue to be used.

“The announcement by Simon Stevens of a review of the approach to setting safe staffing levels means that the work to secure safe levels of staffing in A&E departments and in mental health and community settings 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