Four evidence reviews written to support work NICE carried out on staffing levels in the NHS have been released. Under the Freedom of Information (FOI) Act, the documents had been withheld to give NHS Improvement time to study them in their new remit to consider service improvement. The release of the documents follows an internal review of the FOI decision.
In 2013 the Francis and Berwick reports, published in the wake of care failings at the Mid Staffordshire NHS Trust, identified NICE as a key player to help advise the NHS on staffing levels. The Department of Health and NHS England asked NICE to begin work developing evidence based guidelines focusing on nursing care, one of the main drivers of patient safety.
In July 2014, NICE published the first guideline on safe staffing for nursing in adult inpatient wards in acute hospitals; a second guideline on safe midwifery staffing for maternity settings followed in February 2015. Both were designed to help organisations make decisions about safe and efficient nurse or midwife staffing levels, setting out organisational responsibilities as well as day-to-day actions to be taken on each ward or setting.
In June 2015, NICE was asked to suspend further work on the safe staffing programme as the work would be taken forward by the newly formed NHS Improvement, in conjunction with NHS England. It would become part of a wider programme of service improvement looking at alternative approaches to helping NHS providers achieve the right levels and mix of all healthcare staff.
At the time, work was already underway to produce four evidence reviews in four areas: inpatient mental health settings, adult nursing care in community settings, accident & emergency and management & organisational approaches which support safe staffing in nursing & midwifery.
Although all the evidence reviews had not been through the full development process, NICE planned to publish the completed work to date in July 2015. However the Department of Health confirmed to NICE that the information would be published by NHS Improvement as part of its own safe staffing guideline series.
The decision was taken to withhold the documents. This would allow NHS Improvement time to independently review the information as it developed its own guidelines and ensure it was better placed to respond to any enquiries.
Throughout this time NICE received requests to release the information. In our commitment to act in the interests of the public, decisions made by NICE as an organisation can be called to account.
A panel of NICE board members was convened in January 2016 to conduct an internal review of the FOI decision to withhold the safe staffing documents.
The panel agreed that the decision not to release the evidence reviews in July 2015 was a reasonable one as it would have been likely to have an adverse effect on the value of the documents and could prejudice the planned work of NHS Improvement.
The panel noted that the arguments in favour of releasing the information were very finely balanced. However the panel felt that more weight should have been given to disclosing the documents in the interests of the public, and as a result the panel concluded all of the unpublished evidence reviews should be released.
The information has been released to assist others looking for information on safe staffing. It does not constitute final guidance from NICE.
Future work on safe staffing in the NHS continues to be the responsibility of NHS Improvement.