Safe staffing is the way to end NHS postcode lottery

The RCN England director on the college’s campaign to ensure effective care across the UK

The RCN England director on the college’s campaign to ensure effective care across the UK

Picture: Guzelian

We need no reminder that the first initial of NHS stands for ‘national’, but rarely will two people in two different parts of the country have the same experience of our health service.

While people in one area might be guaranteed an award-winning service, those expecting chemotherapy in another may have to travel for treatment because their local centre doesn’t have enough specialist nurses to keep services running.

It can feel a bit like a lottery at times – a national lottery in which the numbers are your postcode.

When patients receive treatment, they need to know enough nursing staff are available. Staff also need this reassurance to be able to do their jobs. But the lack of an agreed method of setting safe staffing levels across the country is leaving patients, and overworked staff, unprotected.

Nationwide fix

The ability of the NHS to safely staff services – by which we mean having the right number of nurses with the right skills in the right place at the right time – is a nationwide problem, with up to 41,000 nursing posts unfilled. 

The human consequences of services lacking the nurses they need are all too real. Earlier this month, two new reports from the Care Quality Commission revealed children at a trust in Kent were at risk because of ‘unsafe staffing’. And last year in Oxford, a cancer hospital had to cut chemotherapy cycles because nurse numbers were down by two fifths.

The RCN believes this problem needs a nationwide fix. On 14 February at RCN headquarters in London, we kicked off the England leg of our UK-wide campaign for safe staffing levels to be enshrined in law.

From the Angel of the North to Brighton Pier, RCN members and staff from across England came together to help design our campaign and decide the way forward.

Fight on four fronts

As the health service in the UK’s four nations is governed by different laws and devolved administrations, our UK-wide campaign for safe staffing has to be fought on four fronts.

The campaigns may be fought differently in each country, but they are all underpinned by the same five principles (see box).

RCN staffing principles for safe and effective care

  1. A governance framework that details responsibility and accountability for ensuring an adequate supply of registered nurses and nursing support staff is available throughout the health and social care system to meet the needs of the population
  2. Ensuring the right number of registered nurses and nursing support staff with the right knowledge, skills and experience are in the right place at the right time
  3. A workforce strategy addressing national, regional and local levels, detailing the overall aim, strategic objectives and required actions
  4. Workforce plans developed at national, regional and local level to support strategic objectives as detailed in the workforce strategy
  5. Robust commissioning arrangements for pre- and post-registration education and development  


Wales became the first country in Europe to enshrine safe staffing in law. This means that health boards and NHS trusts in Wales now have a legal duty to ensure appropriate levels of nurse staffing in all settings.

In Scotland, the Health and Care (Staffing) (Scotland) Bill completed its second stage earlier this month, and the RCN in Scotland will influence and shape the bill so it works for members. 

But in England there is no law related to nurse staffing. There is no law progressing through the Commons and no plan to introduce legislation. It is time this changed.

Strength of our membership

RCN members have told us what needs to change: they want policymakers to sit up and take notice of a problem that doesn’t just affect them but has a huge impact on their patients.

Our members across the nine RCN regions in England will play a central role in deciding what we want from legislation.

Our greatest strength in this campaign is our membership. Whether you live in Harrogate, Hartlepool or Harrow, it will draw on nursing expertise and experience from all care settings across England, with members at the core of planning and mobilising the campaign.

While newspaper headlines often focus on vacancies in emergency departments, report after report has pointed to staffing shortages as a considerable barrier to safe care across a variety of settings.

A report from the Health Foundation, published earlier this month, outlined a ‘critical moment’ after which it may be too late to address systemic faults – while the workforce is modestly growing, the number of nurses and health visitors is still declining.

Harnessing our passion

The event in London fired the starting pistol on this campaign for safe and effective care. We know how passionate our members are and we want to harness this passion to achieve change. 

We will continue to build solidarity and evaluate our campaign’s effectiveness on a regional level.

There isn’t a set script, but what I will promise is the opportunity for each and every member of the RCN to get involved to create a lasting legacy for the nursing profession and the patients we care for.

Patricia Marquis is RCN England director 

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