A&E departments may be too short-staffed 'almost half the time', says report

Report recommends that A&Es should build in a 'margin of safety' into their staffing plans

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A&E departments may be too short-staffed to cope with demand “almost half of the time”, according to a suppressed report by patient safety experts.

Experts at the National Institute for Health and Care Excellence (NICE) called for the NHS to introduce minimum nurse-to-patient ratios on A&Es last year, but the report was never published and NICE’S research was controversially suspended.

Ministers and NHS chiefs faced accusations at the time that they were seeking to hide the scale of the staffing crisis in the NHS and water down recommendations for more nurses that would have come at a huge cost to the Government.  

In a copy of the NICE guidance, obtained by the Health Service Journal after frequent requests for its publication were denied, experts say that A&E staffing levels set according to historical patient demand leave emergency departments unprepared to cope with frequent surges in demand.

The report recommends that A&Es should build in a “margin of safety” into their staffing plans, even if this meant they were overstaffed during quiet periods.

The Royal College of Emergency Medicine endorsed the findings, saying that “most” A&E departments have “insufficient nursing staff to deal with predictable patient attendance patterns”.

Despite his emphasis on improving patient safety in the NHS, Jeremy Hunt, the Health Secretary, has rejected calls for minimum nurse-to-patient ratios. The Royal College of Nursing said it was “concerning” that the financial cost of alleviating the shortages “may have been a factor in the decision to scrap” NICE’s research.

However, officials in the Department of Health said that the NICE report was an unofficial document, indicating that it should not be considered as guidance by hospitals. Research on safe-staffing has transferred to the new arms-length NHS regulatory body, NHS Improvement, and will be completed later this year, a DH spokesperson said.

But Dr Clifford Mann, president of the Royal College of Emergency Medicine, said that not only were A&Es understaffed half of the time, they were often “as much as 50 per cent” short of the numbers required.

“This guidance from NICE highlights what is self-evident on a daily basis in UK A&E departments. Most have insufficient nursing staff to deal with predictable patient attendance patterns,” he said, adding that the guidance should be formally published and that hospitals should consider it.

The number of A&E attendances has increased by 35 per cent between 2003 and 2015.

Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing said: “These guidelines were put together by experts, looking at strong evidence who found a very clear relationship between the number of registered nurses and patient care.

“The evidence for the importance of having the right number of nurses, and the right ratio of nurses to health care assistants, would have led to new recommendations and guidance on the safe range of nurse staffing levels. 

“These recommendations would have exposed shortages, and this would have had financial consequences. It is concerning that these consequences may have been a factor in the decision to scrap this important work.

Justin Madders MP, Labour’s Shadow Health Minister, said that the decision to block the findings was “deeply concerning”

“Ministers need to urgently set out how they intend to tackle the workforce crisis in the NHS and ensure hospital wards are not left dangerously understaffed,” he said.