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Nurse staffing act in Wales ‘has improved patient safety’

Europe’s first law on nurse staffing levels has reduced the number of serious incidents relating to unsafe staffing and has made a difference to the culture in which nurses work, an inquiry has heard.

This morning, representatives from the Royal College of Nursing (RCN) gave evidence at the Welsh Health and Social Care Committee’s inquiry on the Nurse Staffing Levels (Wales) Act 2016.

“The legislation by itself is not a magic solution to the problem that we don’t have enough nurses”

Lisa Turnbull

The inquiry was set up for nurse leaders to give post-legislative scrutiny of the act, including assessing the effectiveness of the legislation and what progress had been made in extending the act into further settings.

The law, which was implemented following a years-long campaign by RCN Wales, was the first of its kind in Europe to protect nurse staffing levels by making health boards and NHS trusts legally responsible for providing enough nursing staff in their nursing services and those they commission.

During the first evidence-giving session of the inquiry, held this morning, the director of RCN Wales, Helen Whyley, said that many health boards had reported that the number of serious incidents relating to nurse staffing levels had reduced since the act’s implementation.

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She said: “What we’ve seen over the course of the duties [of the act] being applied, [and] is in the public record in terms of health boards’ reporting, is that the serious incidences that they have had on wards…are reduced or appear to have less of a contributing factor around staffing levels.”

Meanwhile, the RCN had also heard anecdotal evidence from members that the law “has achieved its aims in terms of patient safety”, said Ms Whyley.

She added: “Our members say it’s made a difference to them.

“They say it’s made a difference to the culture in which they’re working in as well and it’s made a difference to the way that the health boards take on board their professional judgment in terms of arriving at that staffing level.”

As a result of the act being implemented, Ms Whyley also noted that there had been “a significant increase” in the amount of money that organisations were putting forward to ensure safe nurse staffing levels.

Section 25A of the act has placed an overarching duty on local health boards and NHS trusts to have regard to the importance of providing a sufficient number of nurses in all settings.

The RCN view was that the Welsh Government should consider publishing statutory guidance on this duty, so that it was clearer what was being expected of organisations, explained Ms Whyley.

“The work to extend the act does not seem to be gathering the pace that we would like to”

Helen Whyley

She said: “We would argue that there isn’t sufficient guidance and clarity on the requirements of 25A.

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“We believe that statutory and potentially operational guidance for 25A would really strengthen the obligations that health boards might be able to develop that would allow them to workforce plan better.”

Meanwhile, section 25B of the act goes further and has placed a legal duty on Welsh health boards and NHS trusts to, on certain wards, calculate nurse staffing levels to provide appropriate patient care, inform patients of this number and take all reasonable steps to maintain it.

Originally, section 25B only applied to adult acute medical and surgical inpatient settings, but it was extended in October 2021 to also apply to paediatric inpatient wards.

Since then, RCN Wales has campaigning for the safe staffing requireme nt to be applied across all settings where nursing care is provided, starting with an extension to community nursing services and mental health inpatient wards.

Last year, the college led a petition to extend the act to these settings, which received more than 10,000 signatures and was subsequently debated in the Senedd.

However, no progress has been made on extending the legislation further, and so far the Welsh Government not supported such a move.

Ms Whyley said during the hearing today that the RCN was continuing to push for the extension, noting that much of the groundwork had already been done for extending 25B into community and mental health settings.

“The work to extend the act does not seem to be gathering the pace that we would like to,” she said.

This was echoed by Lisa Turnbull, policy, parliamentary and public affairs manager at RCN Wales, who said: “Section 25B is a proven and effective method and has had great results.

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“We would like to see that extended to areas such as mental health inpatient wards, and community where those things have been developed.”

But both RCN representatives argued that it was important that the legislation was not viewed in isolation, and instead worked alongside other policies and guidance that were being issued in Wales around safe staffing levels.

Ms Turnbull said: “The legislation by itself is not a magic solution to the problem that we don’t have enough nurses and we need to have more nurses working in the NHS.

“There’s lots of work to be done around a sustainable workforce [that] isn’t in the law [and] that’s a different pattern of work.

“But what the law has done is it has allowed us to see what we need.”

Ms Whyley reiterated this and said the legislation should be utilised in the context of the recent NHS pay deal, which promised new strategies to improve retention of nursing staff in Wales, including professional development and flexible working.

She said: “The recent NHS pay deal has some fantastic building blocks in it, that we can now use in order to push that work forward.

“What we have to have is the delivery of that deal that was so hardly fought for by our nursing members.

“A sustainable nursing workforce is central to the delivery of all of our NHS services.”

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