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Scotland unveils bill to ensure ‘safe’ staffing in NHS and care settings

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A bill designed to ensure nurse staffing levels in Scotland are safe has been published by the Scottish government.

The Health and Care (Staffing) (Scotland) Bill places a legal requirement on NHS boards and care services to ensure appropriate numbers of suitably trained staff are in place.

“There is a clear link between effective and sustainable staffing levels and high quality care”

Shona Robison

It will require Scotland’s health boards and care providers to have “suitable staffing in place to enable all patients to receive safe, high quality care”, said the government.

The legislation, if passed, would require the use of Scotland’s existing workload planning tools to work out what safe staffing levels are.

The bill, unveiled on Thursday, makes good on a promise made in 2016 by Scottish first minister Nicola Sturgeon at the Royal College of Nursing’s annual congress in Glasgow and follows a similar statutory move pioneered in Wales.

“We know there is a clear link between effective and sustainable staffing levels and high quality care,” said Scotland’s health secretary Shona Robison.

“This legislation will work in practice by ensuring staffing decisions take account of the needs of service users and staff and are supported by available evidence,” she said. “It will also promote openness and transparency about the basis of staffing decisions.”

“It is about listening to highly skilled professionals and letting them exercise professional judgement”

Theresa Fyffe

There is no fixed ratio for staff to patients in the new bill. Instead, safe staffing will be calculated according to local context such as regular inputting of data on patient need.

NHS Scotland uses a “triangulated approach” which includes two workload measurement tools (professional judgement and one other), present funded and actual establishment data (looking at staff numbers and vacancy rates), and clinical quality indicators evidence.

Under the legislation, a general duty to ensure appropriate staffing will apply to all staff groups who deliver care including nurses, midwives, doctors and the allied health professions in NHS settings.

A more specific requirement to use a staffing method will only apply to nurses and midwives, as well as clinicians in emergency care, in 11 settings: adult inpatient, mental health and learning disability, neonatal, paediatric, community nursing, community children’s and specialist nursing, clinical nurse specialists, small wards, perioperative, maternity, emergency departments.

“Moves to enshrine safe and sustainable staffing levels in law must be paired with action2

Alex Cole-Hamilton

The new bill now be scrutinised by the Scottish parliament and must make it through a number of stages before it becomes an act.

RCN Scotland welcomed the bill’s aims but a spokeswoman said that much would depend on how the details of how the plan would be implemented.

There was also the question of whether using the existing workforce tools would deliver the necessary improvements, she noted.

“Delivering safe and effective staffing in Scotland needs to be about more than putting workload and workforce planning tools on a statutory footing,” said Theresa Fyffe, director of RCN Scotland.

SNP

Shona Robison

Shona Robison

“It is about listening to highly skilled professionals and letting them exercise professional judgement,” she said. “It is also about ensuring that there is the flex in the system to adapt to real time changes in patient dependency and using that live data to plan for the future.”

The Scottish Liberal Democrats responded to the bill’s announcement with an attack on present recruitment levels under the Scottish National Party government.

“Moves to enshrine safe and sustainable staffing levels in law must be paired with action to support existing medical staff and attract new ones,” said Scottish Liberal Democrat health spokesman Alex Cole-Hamilton.

“We know that Nicola Sturgeon’s cuts to training places have caused real damage, spending on agency staff has doubled, and each year thousands of staff feel the need to formally report their concerns over staffing levels,” he said.

In 2016, Wales became the first country in the UK to legislate that there should be safe nurse staffing levels in place.

Unlike Scotland, which is including care settings, the Welsh legislation is currently restricted to NHS adult acute medical and surgical inpatient wards.

In May this year a poll of 1,600 UK adults for the RCN found that 74% were concerned about nursing staffing levels in the NHS.

The Scottish and Welsh laws now put the focus firmly on the NHS in England and Northern Ireland.

Last month, Janet Davies, the RCN’s chief executive and general secretary, revealed that the college would be launching a new campaign this autumn demanding safe nurse staffing legislation in all parts of the UK.

However, a Department of Health and Social Care spokeswoman in England confirmed to Nursing Times that there were no plans for a similar law in England.

“There are over 41,900 more professionally qualified clinical staff on our wards since May 2010 – and the fact that our NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“It is right that in England individual trusts set their own staffing levels to account for unique local needs – we are supporting them with the biggest ever expansion of training places for doctors, nurses and midwives, helping staff work more flexibly and awarding a pay rise to over one million NHS employees,” she added.

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