What do you want from safe staffing legislation?

Now is our chance to create a UK-wide culture change, says the RCN’s Theresa Fyffe

Now is our chance to create a UK-wide culture change, says the RCN’s Theresa Fyffe

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A few years ago, I was not convinced that legislation to ensure staffing for safe and effective care was needed. But I changed my mind.

I have seen too many healthcare decisions in the UK being determined by the availability of cash and staff, and not starting from safe and effective models of care. Too often, coherent workforce strategy and planning gets kicked into the long grass.

If political leaders don’t set expectations on standards of care, clarify who is accountable for what, pay for care and ensure the supply of an appropriate number of students, then nursing staff will continue to carry the can for service failures. 

Thousands of RCN members have described the effects that political decisions have on the care they are able to provide to the public. No one who reads Safe and Effective Care: Nursing Against the Odds can be left in any doubt of the need to act. People receiving care – and our members – deserve better than this.

Legislation is a lever

A safe staffing law is needed in each country in the UK. Legislation enables political leaders to set clear standards and accountability for the workforce in health and care services.

There is an ethical imperative for politicians to be clear about what is acceptable in services that are mostly funded by taxpayers. Legislation is a lever for front-line workers when they need to argue for the right staffing to provide safe and effective care. It can also re-set the balance of priorities between finance and clinical care, which are too often out of kilter.

But the law, by itself, is no silver bullet. Poor legislation won’t help; done badly, it might well make things worse while letting those in power pat themselves on the back. Good legislation won’t have the right impact if it isn’t implemented well, funded properly or supported through scrutiny.

A shift in culture

It can take years for legislation to have an effect, and our members are clear that action is needed now. What our safe-staffing campaign is calling for is a radical shift in culture – so that the right to access safe, effective high-quality care is upheld at all times, with legislators ensuring that clear accountability for staffing of safe and effective care exists. As the RCN’s president Anne Marie Rafferty noted: ‘Creating real culture change takes time, and a lot of hard work, dynamism and a dose of luck.’

‘We can make progress while the public pressure for lawmakers to act grows’

While political momentum for safe staffing laws builds across the UK, we must also do all we can together to improve care. Look at the RCN’s UK principles on staffing for safe and effective care (see box, below). Every one of these can be supported by good legislation, giving teeth to our vision of staffing for safe and effective care.

But we can make progress while the public pressure for lawmakers to act grows. We don’t have to wait for legislation to pass to take action. The evidence is already clear: if you look after staff, they can better meet the needs of patients. If there aren’t enough staff to allow proper breaks, the results can be dehydration, poor nutrition and burnout. 

The RCN’s principles for staffing for safe and effective care


We want it to be clear whose job it is to make sure there are enough nurses to meet patients’ needs.


We want the right number of nurses, with the right skills, to be in the right place, at the right time – so patients’ needs are met.


We want a vision for tackling nurse shortages and making sure nursing helps meet the whole country’s health needs.


We want clear plans for getting the right numbers and skill mix of nursing staff and we want checks to make sure they really happen.


We want the UK governments to educate enough nursing students and develop existing staff, so we can meet patients’ needs.


Speaking out makes a difference

In Scotland, we worked hard to get the Health and Care Staffing Bill strengthened to include the safety and well-being of staff. RCN members who speak out help politicians understand why these things matter. If this amendment holds through the last parliamentary vote, it will be a real success. 

In England, a legislative window is now open, but we aren’t just waiting for the day when a bill becomes reality. We are lobbying to influence legislation and continuing our work to change the wrong-headed culture that says it is okay for a nurse to work without a drink, a healthy meal or a toilet break.

‘Good legislation won’t have the right impact if it isn’t implemented well, funded properly or supported through scrutiny’

That is what is valuable about this campaign. Each nation of the UK is in a different place. We want good, effective legislation everywhere. But we don’t need to have timescales or agendas dictated to us.

We are the most trusted profession in the UK. We are devising solutions, persuading, shouting, cajoling and demanding positive change to improve care by improving nursing staffing – using every avenue open to us, including good legislation.

I urge you to get involved in the RCN's safe-staffing campaign wherever you are in the UK.

Theresa Fyffe is UK executive lead for the Safe Staffing campaign and RCN Scotland director

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