Using legislation to save patient lives

Wales is set to become the first UK country to establish a legal duty for safe nurse staffing levels. A bill being debated this week by the Welsh assembly would require health organisations to enable safe nursing care and take all reasonable steps to ensure minimum staff-to-patient ratios for adult acute beds in hospitals.

Wales is on the cusp of becoming the first UK country to have safe nurse staffing levels written into law. A bill that would force health boards to provide safe levels of nursing numbers has been examined by a Welsh assembly committee and is due to return to the assembly this week for debate.

The bill has had widespread support, including from the RCN, and was introduced by Liberal Democrat assembly member Kirsty Williams. She believes it offers Wales the opportunity to ‘lead the way’ by establishing a legal duty for safe nurse-staffing levels.

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The bill would require all health bodies to ensure they have sufficient nurses ‘to enable the provision of safe nursing care, allowing time to care for patients, sensitively, efficiently and effectively’.

All reasonable steps would have to be taken to meet minimum nurse-to-patient and nurse-to-healthcare assistant ratios for adult acute beds.

Guidance on what this level should be – based on acuity and dependency workforce planning tools – would be issued by ministers. This would be a minimum that could be revised upwards locally. Lead sisters or charge nurses would be supernumerary.

Each health body would have to produce an annual report explaining what it has done to comply and how many times it had failed to ensure safe staffing levels.

Behaviour change

RCN Wales director Tina Donnelly says that workforce forecasts and planning have ignored the need for nurses outside the NHS and in other sectors, such as care homes. Many NHS hospitals are operating at 100% bed capacity, she says, while staffing calculations are often based on 85%. Wales has also relied heavily on agency staff with spending of up to £30 million this year, she says.

Ms Donnelly suggests that investment in better staffing could save money by preventing patients deteriorating and requiring long-term, expensive care.

One argument against a legally binding level is that ministers already have the power to intervene should staffing levels fall below existing guidance – but Ms Donnelly points out this has never been used. ‘Law does change behaviour,’ she says. ‘How can we not have legislation to save lives?’

She points out that minimum ratios already exist for areas such as child care – and there is even a move in Wales to limit the number of dogs one person can look after.

Should the bill become law, she wants to see the boards of organisations held responsible for failing on safe staffing.

However, chief nursing officer for Wales Jean White has warned staff would face difficult decisions complying with the bill. The health and social care committee of the assembly supports the bill, but has called for a number of amendments to prevent unintended consequences.

There is also concern about the cost of additional nurses needed to meet safe staffing requirements. The committee is not convinced that bank, agency and overtime costs – calculated at £132.5 million over the past three years – would be eliminated by the new law. No one is sure how many extra staff would be needed.

Whether or not the bill is passed, it has concentrated politicians’ minds on the need for adequate nurse numbers and how Wales can fill the many nurse posts that are already vacant.

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