Expert advice

Workforce: England is falling behind on safe staffing

Health secretary Matt Hancock would do well to follow the examples from other countries – including our closest neighbours 

Health secretary Matt Hancock would do well to follow the examples from other countries – including our closest neighbours  


Picture: Daniel Mitchell

At a recent RCN conference on assaults on emergency workers, health and social care secretary Matt Hancock suggested he may examine the possibility of introducing safe nurse staffing legislation.

Will this lead to progress? The starting point is to recognise that there has been little national strategic direction on securing safe staffing levels in England in recent years.   

In the face of unprecedented nurse shortages, NHS England has continued to be hands off at a national level. It emphasises local flexibilities – ‘one size doesn’t fit all’ – and local responsibilities to determine localised, evidence-based, methods of achieving safe staffing.   

This advice has continued, despite NHS England also publishing research that highlights that there is virtually no independent evidence to inform the local approaches that it advocates. The result is that England looks like it is falling behind other countries in terms of active government engagement on national shortages and safe staffing.

Countries addressing safe staffing

If Mr Hancock wants to examine working examples of safe staffing legislation, he need look no further than immediately north or west. 

In Scotland, the government is at an advanced stage of drafting safe staffing legislation for health and social care, while Wales already has its legislation in place, currently covering acute care. Both countries are looking at legislation that requires mandatory use of staffing tools, and that will hold senior management to account.

He can also raise his eyes to more distant horizons, such as California in the United States and Victoria in Australia. Both have legislation in place requiring employers to follow specific nurse staffing ratios, shift by shift.

Strong unions

Will England progress to significant safe staffing legislation any time soon? The common thread in these other countries is that safe staffing legislation has been enabled by a government responding to a strong nurses’ union. 

Given the lack of substantial government engagement in recent years, a sudden ministerial shift from talk to serious action on a legislative approach in England is unlikely. But not impossible.


James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh

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