Expert advice

Workforce: Legislation alone won’t solve this staffing crisis

Whether England follows Wales or Scotland’s lead, there are other factors to consider

Whether England follows Wales or Scotland’s lead, there are other factors involved in safe staffing

 Protesters supporting the RCN’s safe staffing campaign in Scotland. Picture: RCN

The RCN has committed to pushing for safe staffing legislation in England. As it mulls over which type of staffing legislation to lobby for at Westminster, another UK country has made progress.

On 2 May, the Health and Care (Staffing) (Scotland) bill was passed by the Scottish parliament, making Scotland the second UK country to put safe staffing into law. Wales was first, introducing nurse safe staffing legislation for adult acute wards in April 2018.

The Scottish legislation is different from that in Wales in that it is not nursing specific – it applies to all clinical groups in health and social care services, giving it a more ambitious reach. This is likely to complicate implementation in comparison with the more gradualist approach in Wales.

Options to consider

The RCN in England has a growing range of legislative options to consider. It could take the whole system approach being introduced in Scotland, or it could mimic Wales and begin with legislation covering only nurses in NHS acute care wards.

It could look at New Jersey and some other US states where there is a requirement to put data on nurse staffing ratios in the public domain, as a way of holding employers to account. Or it could aim for state-wide, legally mandated nurse staffing ratios, such as those that exist in Victoria and Queensland in Australia and California in the US.

Each of these options has pros and cons, but two underlying factors also need to be considered. First, the legislative approaches in these other countries have taken years to achieve, even when governments were friendly towards nurses and trade unions – characteristics not very evident at Westminster currently.

Second, as the RCN in Scotland has made clear, legislation alone will not solve the nursing staff challenges. There must also be a fully funded, long-term workforce planning process.

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



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