New staffing laws in Wales will be fully introduced next year, meaning NHS hospitals will have to calculate and maintain the number of nurses they require using a set method. Chief nursing officer for Wales, Professor Jean White, explains how nurses will be supported to ensure the legislation makes a difference.
Professor Jean White
One of my stated priorities for nursing in Wales is the development of the nursing workforce, in terms of numbers, roles and skill-mix. That is because I strongly believe that to build a safe, high quality health system you must start with the workforce.
In recent years much of my attention has been on developing guidance, tools and, latterly, legislation focussed on this priority.
Three things have happened this autumn that continue a journey I began with executive nurse directors, with the support of the Royal College of Nursing in Wales, over six years ago.
On 2 November we reached the next milestone for the Nurse Staffing Levels (Wales) Act 2016 with the legislation’s statutory guidance launched in Prince Philip Hospital, Llanelli.
This guidance sets out in some detail how the triangulated methodology prescribed in the law should be implemented.
“The legislation will bring a high degree of consistency across the country’s health system as every area will be using the same evidenced-based tool”
In April next year the duty in the act requires application of this methodology to determine nurse staffing levels on adult acute medical and surgical wards throughout NHS Wales.
The second activity happened following the national conference on nurse staffing that happened in Cardiff at the end of September, where the health secretary launched non-statutory guidance on district nurse workforce configuration.
This guidance is drawn from the best evidence available, such as the Buurtzorg model of neighbourhood district nursing seen in the Netherlands, and will be used for planning purposes as NHS Wales implements its primary care plan.
Finally, the Welsh government is funding a project officer to support rapid testing of a paediatric in-patient workforce tool with a view to consider extension of the law.
In order to ensure the statutory guidance for the act was as clear and helpful as possible we conducted a consultation earlier this year.
“I expect ward leaders to be involved in the decisions taken to set the ward establishment, based on their expert knowledge”
It was interesting to see the concerns and queries raised during the consultation and it proved to be a good indicator about people’s understanding of what the law is trying to achieve.
The methodology prescribed in the legislation will bring a high degree of consistency across the country’s health system as every area will be using the same evidenced-based tool, tested and designed for the Welsh NHS system and mandated through my office; and all staff will be assessing patient acuity and dependency using an existing five-tier approach, known as the Welsh Levels of Care system.
Although the mandated workforce tool will give a clear indication of the nurse staffing numbers and skill-mix needed, this is not the end of the story.
All clinical areas and teams have their own set of circumstances which may mean a modification to the numbers suggested by the workforce tool.
I expect ward leaders to be involved in the decisions taken to set the ward establishment, based on their expert knowledge. Ward leaders’ professional judgement about the patient’s needs and outcomes observed, the physical ward environment, and characteristics of the whole ward team is an essential part of the process.
“It will be the board, rather than individual frontline staff, who will be held to account for compliance with the act”
NHS boards are already being asked during meetings with the Welsh government about how they have made planning and operational decisions, based on the new staffing requirements.
My observations are that there is good understanding at board level of their corporate responsibilities in relation to the act; this is not just a matter for the executive nurse director.
When the legislation comes fully into force next year it will be the board, rather than individual frontline staff, who will be held to account for compliance with the act.
The board must ensure that at least twice a year the medical and surgical ward establishments must be reviewed and the number of nurses and support staff posts must be funded and actively recruited to.
“Compliance with the law next year is going to be testing as we all recognise the challenges faced with the international nurse shortages”
If vacancies arise then the organisation must decide whether to fill with bank and agency staff or alter the patient’s pathway to ensure their needs are safely met.
Organisations will have to keep a record of the decisions made in addressing instances where there are difficulties to meet set nursing establishments on the ward as Welsh government will be seeking assurance that the risk to patients have been managed.
Compliance with the law next year is going to be testing as we all recognise the challenges faced with the international nurse shortages but I am hopeful this act is a step in the right direction.
Professor Jean White, chief nursing officer for Wales