Safe staffing guidance


Ensuring services are staffed with the appropriate number and mix of clinical professionals is vital to the delivery of quality and safe care.

NHS Improvement has now produced draft guidance on safe staffing management in acute and learning disability settings, and is seeking feedback on the draft documents until 3 February 2017.

The draft improvement resources advise a flexible, pragmatic approach to safe staffing, and the use of evidence-based tools and appropriate skills mix to assess and meet local need. They present a variety of resources and case studies to help managers plan their staffing safely at strategic and operational levels. The draft documents point to the use of flexible staffing strategies, triangulation and comparison with similar services or teams, and the use of the whole multi-disciplinary team to ensure an agile and appropriate level of care to meet the needs of patients and staff. 

Given the varying nature of services and environments they cover, the draft guidance documents do not recommend a one size fits all ratio of staff to patients. NHS Improvement does still acknowledge the 1:8 ratio previously recommended by National Institute for Health and Care Excellence (NICE), stating;  

“For some services, significant increases in risk occurred well below this threshold. While not giving a clear ‘safe’ staffing level, this evidence reinforces that a 1:8 threshold represents a level at which risk is known to be increased, not an optimal, safe staffing level,”

NHS Improvement recommends that its resources are considered alongside guidance from the National Quality Board (NQB). The improvement resources refer often to the NQB’s expectations for organisations to have the right staff with the right skills, in the right place at the right time. 


The work has been carried out by NHS Improvement after NHS England and the Department of Health suspended work on safe nurse staffing by NICE last year. The Francis report recommended NICE should draw up “evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix”.

Have your say on the draft guidance

The draft resources are available on the NHS Improvement website: 

NHS Employers will be submitting a response on behalf of employers. If you would like to be included in this response, please send your thoughts on the draft guidance to by close of play on 23 January 2017. Otherwise, please submit your individual responses via the survey links on the pages above. 

The resources above are the first in a series of seven, to be consulted on over the next few months.

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