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‘More nurses’ bill needs 19 changes before it can be passed, says committee

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Welsh politicians have agreed that safe staffing legislation for nurses could be “beneficial”, but have called for a series of changes to the draft law to avoid any “unintended consequences” that could occur if it were introduced.

In December 2013, Liberal Democrat Kirsty Williams introduced proposed legislation that could potentially see Wales become the first country in the UK with a legal duty on safe nurse staffing levels.

In the latest development, an influential committee of assembly members has unanimously backed the aims of the proposed legislation, stating that it was “supportive of the general principles of the bill”. However, it also highlighted a number of issues.

The National Assembly for Wales’s health and social care committee noted that if the bill were implemented in its current form it could cause “potentially significant” problems, including diverting nursing staff from other settings.

The committee said the proposed Safe Nurse Staffing Levels (Wales) Bill – initially intended for adult inpatient wards in acute settings – also risked causing increased spend on agency and bank nurses in the short term.

“A number of amendments are required before this legislation is passed, not least to mitigate some of the potentially significant unintended consequences”

David Rees

Other concerns raised were that organisations might be encouraged to recruit less experienced staff and an exacerbation of recruitment issues in the independent sector.

The committee has made 19 recommendations on changes to the draft bill and measures ahead of its proposed introduction.

These include ensuring that guidance produced alongside the bill “places particular emphasis on ensuring that health bodies’ compliance with staffing ratios in adult inpatient wards in acute hospitals does not have an adverse effect on nurse staffing levels in other NHS settings in Wales”.

In addition, the recommendations state this guidance should “place particular emphasis on health bodies achieving a reasonable balance of permanent and agency/bank nursing staff when complying with the statutory staffing ratios”.

Ministers also noted barriers facing NHS organisations that could mean they were unable to comply with the legislation.

These barriers include a shortage of nurses in Wales, a lack of workforce planning and sufficient training places to meet demand, and the additional cost to employers to potentially recruit more staff and report safe staffing levels.

Recommendations included ensuring the legislation does not come into effect until “reasonable time” has passed to allow for additional recruitment of nurses.

The committee also said it should be considered whether the legislation should refer to “arrangements for comprehensive workforce planning” to ensure “sufficient numbers of trained nurses are available across public and independent sectors”.

Other issues raised from the committee’s consultation were whether the legislation should apply to other settings – such as the community – at the same time as it is introduced for inpatient wards.

“The committee recommends that the bill’s commencement provisions be amended to allow reasonable time for the recruitment of nurses”

Health and social care committee

It also noted that it was unclear whether the staffing ratios should apply to Welsh NHS care delivered in other parts of the UK, and care provided in the independent sector – either privately or NHS funded.

The committee has recommended firstly that the bill clearly states the legislation should apply initially only to adult medical and surgical inpatient wards in acute hospitals.

In terms of extending the law to community settings, the committee said there should be an “urgent” review of whether there is enough existing evidence for this to happen at the same time the legislation is introduced for inpatient settings.

Meanwhile, the committee concluded the legislation should not be amended to also apply to Welsh NHS-commissioned or funded care in the independent sector – such as in nursing homes

Instead, the bill should require the Welsh Government to issue additional guidance “in respect of the wider duty for health service bodies to have regard to the importance of safe nurse staffing levels in exercising all their functions”.

The committee rejected the suggestion that the legislation should also apply to privately funded independent healthcare settings and noted that existing regulations for independently funded hospitals existed, which could be amended.

“I firmly believe the ‘more nurses’ bill will save lives by ensuring a safe, appropriate level of nurse staffing”

Kirsty Williams

David Rees, chair of the health and social care committee, said: “The pivotal role of nurses in the delivery of high quality, effective care for patients is widely acknowledged and the committee welcomed the opportunity to scrutinise the bill.”

He added: “We believe that a number of amendments are required before this legislation is passed, not least to mitigate some of the potentially significant unintended consequences that could be created by the bill as currently drafted.”

In response, Ms Williams said: “I firmly believe that the ‘more nurses’ bill will save lives by ensuring a safe, appropriate level of nurse staffing.

“I am particularly pleased that the health committee has concluded that legislation on safe nurse staffing levels could be beneficial, and would build on existing tools and powers in this area,” she said.

“I look forward to giving consideration to the committees’ recommendations on specific amendments to the bill,” she added.

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