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Wales staffing bill 'dilluted' as it takes 'historic step' towards law

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A bill to ensure minimum nurse staffing levels in Wales has passed a further stage in the process of becoming law, following a debate last night.

Members of the National Assembly for Wales agreed to support the bill after voting on a series of amendments to the proposed legislation, including whether to reinsert the word “safe” into its title.

During previous stages of the law-making process, its title was changed to the Nurse Staffing Levels Wales Bill from the Safe Nurse Staffing Levels Bill. 

“Empowering nurses] will be one of the most important outcomes of the legislation, should it be passed”

Kirsty Williams

Last night minsters were accused of “diluting” the bill by those in support of reintroducing the word “safe”, which they said would increase transparency about the intention of the proposed law.

But health minister Mark Drakeford opposed the idea, stating the use of the word “safe” in law was “fraught with difficulty” when being applied to clinical settings that could never be completely free of the risk of harm.

Elin Jones, Plaid Cymru assembly member, said the legal requirement for safe nurse staffing levels would “give some force to the voice of the nurse” who often feel “powerless”.

She noted all mention of the word “safe” had now been removed from the bill, claiming it has been “diluted” by ministers.

Welsh Liberal Democrats party leader Kirsty Williams, who put forward the proposed legislation at the end of 2013, said it would be a missed opportunity not to use the word “safe”, which would “provide greater transparency and public understanding of the bill’s intention”.

However, she said she did not believe it was critical to the success of the bill. Other parts of the legislation – the requirement for nurses to use staffing ratios, acuity tools, and professional judgement – would drive improvements in safety, she added.

Kirsty Williams

Kirsty Williams

Kirsty Williams

Despite support, members voted against the re-introduction of the word “safe” into the bill.

Other amendments debated last night included whether to extend the staffing requirements beyond adult acute medical inpatient wards and surgical wards to other settings.

Those in favour said expanding it would stop nurses being substituted from other areas of the service, but those against said evidence-based tools had not yet been fully developed to help calculate staffing levels for other settings.

Speaking about the benefits of the bill, Ms Williams said she believed it would empower nurses and that international evidence showed it would result in improved outcomes for its intended settings.

However, she said the specific legal requirement for safe staffing across a wider range of settings should not apply until tools had been developed for these services.

“I think [empowering nurses] will be one of the most important outcomes of the legislation, should it be passed, in strengthening the arms of nurses and the profession,” she said.

“What we know from our experience in reading the reports into scandal Mid Staffs is that chief nursing officers were put under tremendous pressure by directors of finance at board level to make cuts to their staffing establishment and there was nothing nurses could turn to, to strengthen their arm,” she added.

Following a vote, the proposed changes to extend to other settings were not supported.

An amendment for the legislation to apply to services outside of Wales commissioned by NHS organisations within the country, was put forward by Darren Millar, Welsh Conservatives assembly member.

Welsh Assembly

Darren Millar

Darren Millar

But Ms Williams highlighted the lack of control the NHS in Wales had over English policy and urged assembly members to address this instead.

“Of course you are right to say Welsh patients treated in English hospitals should not be disadvantaged…but unfortunately we have no competence over the English health service system,” she said.

“I would urge Darren to…persuade the Department of Health to call off Monitor when they are asking people to cut nurse staffing levels, to reinstate the work of NICE [on safe nurse staffing levels in England] which Jeremy Hunt has stopped and to restart that work,” she said.

Assembly members voted against the amendment.

Commenting on the bill reaching the end of this stage, Tina Donnelly, director of the Royal College of Nursing Wales said it was a “historic step” towards improving patient care.

She added: “Kirsty Williams has led the way in championing this bill and it has been heartening to see how constructively Mark Drakeford has worked to make this bill a reality. It has also been wonderful to see strong support from the Conservative party and Plaid Cymru as well.

“Governments across the United Kingdom can really learn from this approach to safeguarding patient care.”

The bill will now go to its fourth and final stage on Wednesday next week.

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