Author: Manish Patel

Adult Acute Assessment Units1

Safer Nursing Care Tool (SNCT)

The National Quality Board (NQB) publication ‘Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time: Safe, sustainable and productive staffing’ (2016) outlines the expectations and framework within which decisions on safe and sustainable staffing should be made to support the delivery of safe, effective, caring, responsive and well-led care on a sustainable basis. The publication makes reference to the NICE guidance - the ‘Safe Staffing Guideline for Nursing in Adult Inpatient Wards in Acute Hospitals’, which was published in 2014 and advises that it is considered in conjunction with the National Quality Board guidance.
Both publications emphasise the need for developing evidence based, patient need driven, staffing levels in inpatient ward settings utilising a NICE endorsed toolkit alongside the guidance. The Safer Nursing Care Tool (SNCT) is one method that can be used to assist Chief Nurses to determine optimal nurse staffing levels. SNCT received NICE endorsement in 2014 - acknowledging that it meets the requirements set out in the NICE guideline ‘Safe staffing for adult inpatient wards’ (NICE, 2014).
The Safer Nursing Care Tool (SNCT) for Acute Assessment Units is an adaptation of the original Safer Nursing Care Tool for adult inpatient wards developed in 2006 and most recently updated in 2026. It has been developed to help NHS hospitals make evidence based decisions on staffing in adult Acute Assessment Units in line with the National Quality Board’s expectations using patient acuity and dependency to inform these decisions. The 2026 version of the tool incorporates updated patient care levels descriptors aligned to refreshed nursing resource multipliers. They provide for traditional ward layout with a separate module for single roomed wards as well as levels of care for one-to-one care and two-to-one care. All previous versions of the tool are no longer valid.

Ensuring safe, sustainable and productive staffing
The Safer Nursing Care Tool is:
A NICE endorsed, evidence based, tool which enables nursing staff to assess the acuity and dependency of patients, which is aligned to a staffing multiplier to provide a recommended establishment based on the actual needs of the patients
Appropriate for use in any adult Acute Assessment Unit in acute hospitals within England (although further work is underway to adapt the tool for use in other clinical setting and other countries, see section on ongoing development of the tool)
Used in conjunction with Nurse Sensitive Indicators (NSIs), patient and staff outcomes that can be linked to nurse staffing such as patient falls and pressure ulcer incidence
Able to support benchmarking activity in organisations when used across trusts. This will guide consistent decision making in setting safe and sustainable nurse establishments in line with agreed standards across similar care settings in England.

Benefits of the Safer Nursing Care Tool
SNCT is a NICE endorsed tool meeting the principles that should be considered when evaluating decision support tools described in ‘Safe, sustainable and productive staffing - An improvement resource for adult inpatient wards in acute hospitals’ (NHSI 2018)
Assessment of acuity and/or dependency
Accurate data collection methodology
Nurse Sensitive Indicators organisation-level metrics to monitor the impact of staffing levels on the quality of patient care and outcomes, the use of resources and on staff themselves’ (NHSI 2018) allied to acuity and/or dependency measurement
Nursing multipliers to support professional judgement

1An acute assessment unit (AAU), also often called acute admissions unit or acute medical unit, is a short-stay department in some hospitals that may be linked to the emergency department, but functions as a separate department. The AAU acts as a gateway between a patient's general practitioner, the emergency department, and the wards of the hospital.

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The development process
The Safer Nursing Care Tool (SNCT) was developed and validated by NHS experts. This included recalibrating the tool using the UK Nursing Database, which at that time included 1,000 best practice wards (those achieving a pre-determined quality rating) and some 119,000 nursing interventions delivered to almost 2,800 patients in 14 care groups over two years. This was important to ensure the staffing recommendations derived were not perpetuating poor practice standards.
The SNCT tool (2006) was tested in teaching and district general hospitals in England and across NHS Scotland, to confirm that the tool was robust and easy to use and provided appropriate nursing establishments.
In 2018, the Shelford Chief Nurses commissioned an expert working group to complete a review of the tool, its criteria definitions and to update the multipliers values (associated nursing resource) to ensure the SNCT is still current and applicable.

The review took into account:
The ageing population’s impact on inpatient acuity and dependency
Single room ward design
Supporting inpatients with increasing care requirements due to risk of falls, confusion or mental health needs (enhanced care)
The refreshed version of the tool, most recently updated in 2026, incorporates 236,079 staffing interventions, with 123,250 service quality standards as well as updated patient care levels descriptors aligned to refreshed nursing resource multipliers.
They provide for traditional ward layout with a separate module for single roomed wards as well as levels of care for one-to-one care and two-to-one care.

The opportunity
To license the Acute Assessment Unit Safer Nursing Care Tool.

The original tool was formally approved by the Shelford Chief Nurses and NHS England in 2013 and endorsed by NICE in 2014. DELET

LICENSING ENQUIRIES
IMPERIALCOLLEGE LONDON
Email: nhsinfo@imperial.ac.uk
GENERAL INFORMATION
THE SHELFORD GROUP
Email: info@shelfordgroup.org
Web: www.shelfordgroup.org

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