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Francis criticises NHS England safe staffing intervention

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Sir Robert Francis has expressed serious concerns over NHS England’s decision to suspend the work he recommended to determine safe staffing guidelines.

  • Programme was recommended in Francis report
  • Francis disputes Simon Stevens’ argument that NICE would require a “mechanistic” approach
  • Health secretary re-commits to implementing Francis recommendations


The chairman of the public inquiry into poor care at Mid Staffordshire Foundation Trust spoke out after LGC’s sister title Health Service Journal revealed NHS England chief executive Simon Stevens had asked the National Institute for Health and Care Excellence to cease work on safe staffing levels.

The halted programme was a specific recommendation made by Sir Robert. In his 2013 report he described NICE as the “accepted authority” to carry it out. The recommendation was immediately accepted by health secretary Jeremy Hunt.

Sir Robert said he was “surprised and concerned” by the development and pointed to the fact NICE was set up to be independent of the NHS and the wider policy structures.

In a leaked email obtained by HSJ on Wednesday, NICE chief executive Sir Andrew Dillon told members of the safe staffing programme its work would be suspended with immediate effect.

This followed Mr Stevens announcing chief nurse Jane Cummings would include safe staffing in its wider service reviews. He said this would avoid “a more mechanistic approach” of nurse ratios.

Sir Robert, who is also a board member of the Care Quality Commission, told HSJ: “While there is nothing wrong and indeed everything to be said for NHS England reviewing staff levels, I specifically recommended the work which NICE has been undertaking for a reason, namely they have an evidenced 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. It is important to establish practical guidance, based on the needs of patients, which will enable providers, commissioners and service users alike to understand whether a particular service is safely staffed.”

Directly responding to Simon Stevens, Mr Francis said: “I do not regard this as requiring a ‘mechanistic’ approach, or that NICE methodology as having to produce such a result.

“Therefore 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.”

Health secretary Jeremy Hunt told HSJ he would personally ensure progress continued on safe staffing: “I am the secretary of state who is responsible for implementing the Francis report, and there will be no higher commitment. Whoever is responsible for that work, I will hold their feet to the fire to make sure we continue the excellent progress we’ve made towards safe staffing.”

Mr Hunt said he supported NHS England’s decision to ensure “a better way of measuring safe staffing, which is more subtle than simply numbers of bodies per shift.”

RCN chief executive Peter Carter said: “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.”

NHS England declined to respond.

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