Health boards and NHS trusts in Wales have been issued statutory nurse staffing guidance by the government, ahead of the introduction of new laws next year.
The final version of the document, published on 2 November following a consultation, lays out the steps NHS organisations must take to calculate and maintain staffing under the Nurse Staffing Levels (Wales) Act 2016.
“The [staffing] calculation made by the designated person should be informed by the registered nurses within the ward”
Statutory guidance for Wales staffing laws
The law comes fully into effect in April 2018, when it will apply to all NHS adult acute medical and surgical inpatient wards.
The guidance states a “designated person” at each local health board or NHS trust – who must be a registered nurse or midwife – should calculate nurse staffing levels based on the use of professional judgement, an evidence-based workforce planning tool, and consideration of how far patients are sensitive to nursing care.
Following feedback during the consultation, it also now states frontline nurses, including those working on affected wards, should be able to contribute their views when staffing is being calculated.
“The calculation made by the designated person should be informed by the registered nurses within the ward and the nursing management structure where the nurse staffing level applies,” said the guidance.
“This means that the opinions of the ward sister/charge nurse, the senior nurse/matron/lead nurse, and the directorate /division nurse director/chief nurse/clinical board nurse, should be provided to the designated person,” stated the final version of the document.
In addition, it explained that the chief nursing officer for Wales would inform health boards what workforce planning tool is needed.
“The CNO will determine that the [workforce planning] tool… includ[es] ratios for total registered nursing time against patient need”
Statutory guidance for Wales staffing laws
“The CNO will determine that the tool utilises the best available evidence, including ratios for total registered nursing time against patient need in its algorithms,” said the guidance.
During the consultation, NHS staff members said they believed ward managers should be able to feed into staffing decisions, because the designated person would need an acute understanding of issues on the ground.
Meanwhile, a large proportion of health boards and NHS trusts taking part in the consultation had said a specific workforce planning tool should be identified within the guidance, warning that without it, the use of professional judgement would be less reliable.
However, the guidance does not provide any further details about exactly which senior nurse the “designated person” responsible for calculating the staffing levels should be in each trust – despite a quarter of NHS trusts and health boards in the consultation saying they wanted this to be explicitly stated as the executive director of nursing.
“I’m very keen to see the health boards use this guidance to bring the legislation to life and affect positive change”
Similar to the draft version, the final guidance said the person should have an understanding of the complexities of setting nurse staffing in a clinical environment and should be of “sufficient seniority” within the organisation “such as the executive director of nursing”.
The final document also does not state how the designated person could be held accountable for staffing decisions and what sanctions will apply to boards if they do not comply with the laws – this was despite a quarter of health boards and NHS trusts asking for details of this in the consultation.
Launching the guidance, Wales’ health secretary Vaughan Gething said: “Wales is the first country in Europe to legislate on nurse staffing levels and I’m proud of what we have achieved so far.”
“The evidence unequivocally tells us that having the right number of registered nurses reduces patient mortality and improves patient outcomes,” he said.
“Ensuring patients have safe, high quality care was one of the main reasons why we supported the introduction of the act,” said Mr Gething.
“I’m very keen to see the health boards use this guidance to bring the legislation to life and affect positive change for the benefit of our patients in Wales,” he added.
“It is essential that we have a nursing workforce that has the right skill set, in the right numbers”
CNO for Wales Professor Jean White said the publication of the staffing guidance was a “big step” towards ensuring the NHS had enough nurses.
“Nurses are the largest section of the health workforce and fulfil roles right across our health and social care services,” she said. “It is essential that we have a nursing workforce that has the right skill set, in the right numbers with an appropriate skill-mix, deployed at the right time to meet patients’ needs.
“The Nurse Staffing Levels (Wales) Act 2016 requires the NHS to ensure there are enough nurses to sensitively care for patients and we’re working hard to help get those numbers right,” she said.
”The publication of this statutory guidance – developed in partnership with the NHS and key partners like the Royal College of Nursing – is a big step towards making that a reality,” she added.