Wales has many things that make it stand out from other parts of the UK – and I don’t just mean its language, history and wonderful scenery.
Its differences are reflected in the types of laws being passed by the National Assembly for Wales and national policies such as prudent healthcare, which it is pursuing. These differences are bringing much positive attention to Wales.
When the Well-being of Future Generations (Wales) Act 2015 was passed, which sets requirements for public bodies to ensure present needs are met without compromising the needs of future generations in Wales, the United Nations said “What Wales is doing today, the world will do tomorrow”.
This is a world–first piece of legislation about sustainable services so it should be no surprise that its approach to legislation for nurse staffing levels on adult inpatient medical and surgical wards is similarly unique. Wales is the first country in Europe to have taken this approach and attention will continue to be paid as the requirements of the act are rolled out in coming years.
Although the act began as a private members’ bill, the subsequent Welsh Government amendments to it brought the proposals in line with government policy. This means there are no fixed ratios or minimum numbers quoted in this act but it sets out the steps to be taken to enable frontline staff and managers to determine what is the right nursing establishment to meet the needs of the patients cared for in that environment.
The approach described requires the triangulation of evidence: firstly the application of a validated and tested workforce tool, which should give a strong indication about the size and skill mix of the establishment on that ward. Next is the requirement to look at patient outcomes that are sensitive to nurse staffing levels, such as falls or pressure ulcers. In other words: what are the outcomes saying about the quality and safety of care on that ward. Lastly, is the application of professional judgement in looking at the other factors important in that ward, such as bays and rooms layout, experience and skills of team members and ward manager, what recent inspections indicate and so on.
By combining all three things, the responsible officer will determine what the establishment should be. From this establishment, day-to-day rosters will be drawn up and decisions around recruitment made. It is anticipated that the process will be undertaken at specific intervals to support the annual planning process for the health board; alternatively it can be done if the ward materially changes the types of patients being cared for.
I am sure many of you are thinking: well, this is just good practice surely? And, in essence, you would be right. However, as this is set in legislation, the monitoring and reporting of compliance by the health board, inspectorate and to the National Assembly for Wales by the minister, will enforce a level of scrutiny on compliance that guidance alone cannot bring.
Before the act can commence, guidance must be prepared and consulted on. The current work to finalise the workforce tool to be used will also be completed this year. All health boards are being encouraged to prepare for the act’s introduction and there is now an expectation that it will feature in all future planning cycles.
The act has the potential for expansion to other areas as the evidence emerges. Therefore our work in mental health, community, paediatrics, health visiting and care homes will continue. Having the right workforce is essential for the wellbeing of our patients.
Jean White is chief nursing officer for Wales