When drafting these recommendations the Safe Staffing Advisory Committee discussed evidence from the systematic reviews and an economic analysis report described in section 2. In some areas there was limited or no published evidence. In these cases, the Committee considered whether it was possible to formulate a recommendation on the basis of their experience and expertise. The evidence to recommendations tables presented in appendix 1 detail the Committee's considerations when drafting the recommendations.
The Committee also identified a series of gaps in the evidence – please see section 3 for further details.
When drafting the recommendations the Committee took into account:
whether there is a legal duty to apply the recommendation (for example, to be in line with health and safety legislation)
the strength and quality of the evidence base (for example, the risk of bias in the studies looked at, or the similarity of the populations covered)
the relative benefits and harms of taking (or not taking) the action
any equality considerations.
Recommendations using directive language such as 'ensure', 'provide' and 'perform' are used to indicate the Committee was confident that a course of action would lead to safe midwifery care.
If the quality of the evidence or the balance between benefits and harms means that more time should be taken to decide on the best course of action, the Committee has used 'consider'.
Recommendations that an action 'must' or 'must not' be taken are usually included only if there is a legal duty (for example, to comply with health and safety regulations).