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Wales passes first hurdle towards law on nurse staffing levels

Wales is one step closer to becoming the first UK nation to enshrine safe nursing staff levels in law.

On Wednesday afternoon Welsh Assembly members voted through proposals drafted by Liberal Democrat Kirsty Williams to create a legal duty for safe staffing levels.

Her bill will now progress to the committee stage where it will be debated in detail.

Other UK nations have shied away from legislating on safe staffing but Ms Williams told the assembly this was a chance for Wales to “lead the rest”.

Outlining her proposals, she cited examples from abroad where she said laws on safe staffing have been successfully introduced.

In California a law to maintain nurse to patient ratios in acute settings has seen a significant reduction in mortality rates.

Meanwhile, in the Australian state of Victoria, a law on minimum staffing introduced in 2012 led to better recruitment and retention of nurses and reduced reliance on agency staff, as well as other benefits, said Ms Williams.

“Our NHS cannot become an easy target when it comes to balancing the books”

Kirsty Williams

She warned that workforce planning and non-compulsory guidelines on safe staffing were simply not working in Wales.

“The fact is that we already have guidance on staffing levels from the chief nursing officer and those levels are not being met consistently across Welsh health boards,” she said.

Kirsty Williams

Kirsty Williams

“We need legislation to provide the strong backing that managers need to ensure that the workforce in our NHS cannot become an easy target when it comes to balancing the books.”

Assembly members from all parties agreed to allow the proposals to proceed to the next stage with 39 voting in favour, 12 abstentions and no votes against.

But some, including Welsh health minister Mark Drakeford, questioned the need for a new law warning it could have “unintended consequences”.

There was a risk minimum levels would “become the maximum” and community hospitals could be stripped of nurses to fulfil staffing requirements in acute care, he said.

Set ratios removed the flexibility for nurses to exercise their own professional judgment about what acceptable and could damage integrated working as the health service evolved, he added.

Mr Drakeford said there remained “high and substantial hurdles” to overcome in order to create workable legislation, which had “no doubt contributed to decisions elsewhere in the UK not to proceed in this way”.

Mark Drakeford

Mark Drakeford

Other assembly members questioned whether the law would apply to community settings and where specialist nurses fitted in.

Ms Williams said nurse-patient ratios would not be put on the face of the bill as that was for “the profession to decide”.

She said ratios for community settings could be included at a later stage, but at the moment the evidence of the benefits was less strong.

“There can be no compromise on the need for mandated, minimum registered nurse staffing levels”

Tina Donnelly

Tina Donnelly, director of the Royal College of Nursing in Wales, said: ”We are pleased that our assembly members have been listening to nurses and patients about the importance of nurses having time to care and the need for adequate staffing levels.

“There can be no compromise on the need for mandated, minimum registered nurse staffing levels,” she added. “There is a growing body of evidence which shows that nurse staffing levels make a difference to patient outcomes and patient experience, quality of care, recruitment and retention of nursing staff and the economic efficiency of care delivery.”

Readers' comments (8)

  • Having trained in Melbourne, Victoria I feel the need to point out that the mandatory nurse-patient ratio came into effect earlier that you reported - 2001 or 2002 (in under a labour govt...though they tried to get rid of it, and failed, every chance they got) but I'm really happy that Wales is starting (hopefully!) to move in this direction. One day the rest of the UK (especially nurses themselves) will follow suit hopefully and the constant chronic, dangerous understaffing will be reversed/improved.

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  • Like with most announcements there doesn't appear to be a plan, where are these nurses going to come from? What happens if an area doesn't have the required number will the ward close....I don't think so? This could make patients more anxious about being admitted onto wards that don't have the required numbers.

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  • michael stone

    Another report on page 16 of today's Times from the CQC - Mike Richards has commented:

    "People sometimes ask, is compassionate care a thing of the past? Absolutely not, it’s very much alive and well. But where individuals are under such strain, usually due to staffing levels, compassion can be overwhelmed.”

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  • Hopefully its not just getting 'nurses' (anyone who looks like a nurse, difference between registered and non-registered) and those not doing whole shifts of direct patient care.

    Any numbers published I'd assume is for when the patients are at their most stable - so when patients' acuity levels increases, then staff numbers should increase correspondingly.

    Also different skills sets of HCAs and Registered Nurses should also be considered. Its no good when someone can't take a full set of observations and understand when there are concerns to be raised, or when you need someone who can give intravenous medication and someone else to check things together, and no good if senior nurses are called away frequently to deal with off-ward problems.

    Hopefully its going to be just more than a reduction in mortality rates, it should also be an improvement in patients' recovery rates, quality and delivery of care, and improved staff health and well-being, reduced sickness and turnover.

    May be if the executive team all worked a week, bimonthly, eg. as a porter or HCA, especially those from non-clinical background would spot how to improve things better and then follow up to see if further improvements could be made.

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  • tinkerbell

    “We need legislation to provide the strong backing that managers need to ensure that the workforce in our NHS cannot become an easy target when it comes to balancing the books.”

    Exactly!

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  • And what happens when we come on duty and there are not enough staff, the agency can't fill the vacancy, the management can't find help from other wards? - yes we can report it, make numerous phone calls but the patients still need looking after and we still need to take admissions.

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  • I have to agree with 11.02am.

    How on earth is this going to be controlled? Utilising acuity modelling tools is no doubt the answer to the first 10% of the puzzle, but how will hospitals then manage their staff better to ensure there is the visibility and flexibility to be assured that wards can remain safely staffed in accordance with any legislation?

    I've listened and read all inpouts and this seems to be a major gap.

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  • 'On Wednesday afternoon Welsh Assembly members voted through proposals drafted by Liberal Democrat Kirsty Williams to create a legal duty for safe staffing levels.'

    I can't see anybody voting in the picture. all the seats look vacant!

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