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NICE outlines the cost of safe staffing

Implementing the guidance is likely to cost trusts around £200m, says NICE

Ingrid Torjesen

Wednesday, 23 July 2014

The National Institute for Health and Care Excellence has said that its first safe staffing guideline for nursing in adult inpatient wards in acute hospitals, published this month, is likely to have a negligible impact on staff finances.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE said: “We know that there has already been progress in the NHS to implement safer staffing practices on acute wards. Implementing the NICE guideline is unlikely to have significant financial impact in many trusts, but it is possible that a headline additional cost of 5% (around £200m) could be incurred, building up over more than one year, but it could well be less.

“Safe care is a good investment which has the potential to significantly reduce costs to the NHS.” NICE has issued a commentary which outlines the potential staff cost impact and benefits, as well as capturing existing NHS plans for the financial and resource impact of safe staffing.

The Department of Health and NHS England asked NICE to produce a resource impact commentary on its staffing guideline, which has just been published.

It found that between March 2013 and February 2014 registered nurse numbers in acute inpatient ward settings increased by approximately 3% (full time equivalents, FTEs) and healthcare assistant numbers also rose by approximately 7% (FTEs). The growth in the last 12 months is in contrast to the previous 3 year period, in which approximate numbers for the overall staff group remained relatively stable.

The increase is a reaction to the Francis report on Mid-Staffs. According to the Foundation Trust Network, the total amount that NHS foundation trusts and trusts have invested or will invest in care improvements post-Francis, for the 2-year period 2013/14 and 2014/15, is £1.2 billion. At least 90% of this investment was stated as being to provide for extra staff and recruitment costs, particularly nursing staff.

The total staff cost impact for implementing the NICE guideline in acute wards ranges from zero to £414 million with a mid-point at £207 million. The mid-point cost impact represents approximately a 5% increase in staff costs over current planning projections. The range represents the uncertainty in knowledge about exactly how much NHS organisations have already invested in care improvement and increased staff levels.

There will be cost benefits for trusts achieved through improved patient outcomes as a result of implementing the guidance. These cost offsets are excluded from the net staffing cost and include:

  • Reduction in the number of pressure ulcers: total costs in the UK were estimated as being £1.4–£2.1 billion or around 4% of the total NHS expenditure in 2004.
  • Reduced risk of healthcare acquired infections: the cost to the NHS of surgical site infections is estimated to be around £700 million a year.
  • Potential reduction in bed days due to providing more effective care: potential resources released as a result of a reduced hospital length of stay have been estimated at £236 per bed day (national tariff, 2014-15).
  • Reduced risk of litigation claims due to poor care: the average cost of a claim classed by the NHSLA under the ‘nursing’ category was £75,000 plus the claim excess and legal advice costs.  

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