Fresh calls for Wales to extend safe nurse staffing law

RCN Wales has published its annual report into the “progress and challenge” in delivering safe and effective care, which analyses how far the Nurse Staffing Levels (Wales) Act 2016 is being adhered to.

“As the nursing workforce continues to face challenges in both recruitment and retention, the ambitions of Section 25A remain largely unmet”

RCN Wales report

This year’s report focused on three sections of the act: 25A (a non-statutory duty for health boards to provide sufficient nurses), 25B (a statutory requirement for health boards to safely staff adult acute medical and surgical wards and children’s wards), and 25C (a statutory requirement for health boards to use a specific method to calculate the nurse staffing level for any 25B-covered ward).

It found that many health boards were not publishing data on their adherence to Section 25A, which has no statutory guidance attached to it and, instead, states that boards should “have regard to the importance” of it.

As a result, many wards not covered by the other areas of the legislation remained understaffed, with no legal impetus on trusts to track, let alone correct, this, warned the report.

“Evidence of compliance with Section 25A is sparse, and consequences for non-compliance are few,” the report stated.

“As the nursing workforce continues to face challenges in both recruitment and retention, the ambitions of Section 25A remain largely unmet,” it added.

However, the RCN said Cardiff and Vale University Health Board, which is one of the largest NHS organisations in the country and employed 14,500 staff, had partly bucked this trend.

Its board papers showed it had gathered data on its mental health wards’ staffing levels not complying with the duties laid out in Section 25A of the 2016 act, said the RCN.

The board noted this occurring in both 2019 and 2020 but, by 2022, the executive director of nursing had signed off on the staffing levels as compliant.

The RCN report said that if Section 25A gave a statutory duty to health boards to adhere to its staffing requirements then more boards would follow the example of Cardiff and Vale.

It formally recommended that the Welsh Government should develop statutory guidance for Section 25A, which would make safe staffing effectively a legal requirement for all wards in Wales.

This is not the first time the RCN has asked for this move. In 2022, it campaigned for safer staffing to be applied in all settings where nursing care was provided – but a petition was defeated in the Senedd. 

The RCN also recommended that the government add more teeth to Sections 25B and 25C of the act, by making “clear consequences” for not complying with them, something it claimed was currently missing.

It noted, however, that the statutory guidance attached to 25B for acute wards was helping ensure that the needs of patients were met.

The report cited the example of one health board, where incidents reported in wards covered by 25B “fell sharply” in the year the act came into force.

At another, it noted that patient incidents involving a failure to maintain the nurse staffing level remained “extremely low” since the law was implemented.

RCN Wales said this evidence from health boards showed the need for more types of wards to be covered by 25B.

As a result, the college recommended that the Welsh Government set out a timeline for when mental health inpatient wards and community settings would be wrapped into Section 25B.

It also reiterated a call for Health Education and Improvement Wales (HEIW) to commission post-registration education in order to create a “sustainable supply” of advanced and consultant-level nurses.

Implementing these recommendations, the college argued, would mean staffing levels in the country were safe.

A spokesperson for the Welsh Government’s Department of Health and Social Services noted that, when the 2016 act was passed, legislators deemed statutory guidance for Section 25A as “unnecessary”.

The spokesperson said that this position “still stands” and that it was shared too by the executive nurse directors of the health boards in Wales.

But they added that the government would “explore” the potential creation of “operational guidance” for boards to have consistent staffing outside of wards covered by Section 25B through its All-Wales Nurse Staffing Programme.

Meanwhile, the spokesperson said: “In response to an evolving workforce and service needs, HEIW funding for postgraduate education has significantly increased, from £0.5m in 2016, to £2.5m in 2023.

“A wide range of education and training is also available to nurses, midwives, allied health professionals and health care scientists,” they said in response to the RCN’s call for more post-registration education.