What next for a proposed law on nurse staffing levels?

2 June 2015

Article by Sian Thomas, National Assembly for Wales Research Service

This is a picture of a patient's arm with a drip attached

Image from Wikimedia Commons. Licensed under the Creative Commons.

On Wednesday 3 June, the Assembly will consider what’s next for proposals by Kirsty Williams AM to bring in a new law relating to safe nurse staffing levels.

What is the Bill trying to achieve and why?

The Safe Nurse Staffing Levels (Wales) Bill seeks to ensure that nurse staffing levels within the NHS in Wales are sufficient to provide safe, effective and quality nursing care to patients at all times. Assembly Members will now debate and subsequently decide whether they agree with the general principles of this proposed legislation.

When first introducing the Bill, Kirsty Williams said:

‘The premise of this Bill is simple: nurses with fewer patients to care for can spend more time with each patient, and, as a result, they can provide better care.’

She also says that ‘the pivotal role of nursing staff and the importance of ensuring appropriate nurse staffing levels has been highlighted in a number of recent high-profile reports and research findings’ relating to the NHS both in Wales and in England. These include the 2013 ‘Francis Report’ into Mid Staffordshire NHS Foundation Trust and the 2014 ‘Trusted to Care’ (‘Andrews Report’) on the review of the Princess of Wales Hospital and Neath Port Talbot Hospital.

Nurse to patient ratios?

The Bill has an ‘overarching duty’ on health service bodies in Wales to have regard to the importance of nurse staffing wherever NHS nursing care is provided.

As currently drafted, the Bill would also introduce minimum nurse staffing ratios and require local health boards to ‘take all reasonable steps’ to maintain them. Initially this duty would apply to ‘adult inpatient wards in acute hospitals’ and Kirsty Williams has clarified that it is her intention that these be defined as ‘medical and surgical wards that provide overnight care for adult patients in acute hospitals’. The Bill allows for staffing ratios to be extended to other settings in NHS Wales.

Since 2012, non-statutory guidance issued by the Chief Nursing Officer (CNO) has included a recommended daytime ratio of 1:7 nurse to patients. The Minister for Health and Social Services has said that this ‘is not a compulsory requirement in itself’ and that ‘this is only a guiding figure to assist local considerations of nurse staffing levels’. The CNO has said that there has been ‘a very strong direction of travel ‘ towards compliance with existing guidance. However Kirsty Williams argues that legislation is needed given local health boards have not fully complied with the guidance during the past three years since it was first issued.

Evidence and reports

The Bill has already attracted much interest and scrutiny. The Assembly’s Health and Social Care Committee has already been considering evidence relating to the proposed legislation since January 2015. Whilst its report recommended that the Assembly should agree the general principles of the Bill, it also concluded that a number of amendments were required. In particular, the Committee was concerned about the potential for some significant unintended consequences and made 19 recommendations for change. David Rees AM, chair of the Committee, sets out more detail on the Committee’s scrutiny in his recent blog.

Since the Committee’s report was published on 8 May the Welsh Government subsequently published its own report into Research on Nurse Staffing Levels in Wales on 29 May.

If Assembly Members agree with the general principles, the Bill will proceed to the next legislative stage where any proposed amendments will be considered in detail by the Health and Social Care Committee. You can watch the plenary debate live on Senedd TV at approximately 3pm on Wednesday 3 June.

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