Focus: Your guide to staffing legislation in Wales and Scotland

Scotland flag

Your guide to pioneering staffing legislation in Scotland

The legislation secured in Scotland has been widely described as ground-breaking and world-leading.

The Health and Care (Staffing) (Scotland) Bill is the first in the UK to cover both health and social care services and all clinical staff groups. It was unanimously passed by Scottish Parliament in May 2019.

The bill places a legal duty on health and care organisations to ensure services are staffed to an “appropriate” level to deliver safe and high-quality patient care, and to also protect the wellbeing of the staff themselves.

While stopping short of implementing staff-to-patient ratios, the bill mandates that staffing decisions should be made while taking into account the nature of the care being provided as well as patient numbers and acuity.

Under the law, organisations across Scotland must follow a “common staffing method” using tools agreed by the government that help guide decisions.

Staff levels must be assessed in “real-time” and any risks to patients or professionals must be reported to the clinical leaders in that area.

Escalation processes must be in place for risks that cannot be mitigated and any “severe and recurrent risks” must be acted on, according to the bill.

The legislation places a legal responsibility on organisations to provide staff with “appropriate” training to carry out their roles.

Those with lead clinical responsibility must be given “sufficient time and resources” to carry out their leadership duties as well as their other professional responsibilities.

Scottish Parliament

Scottish Parliament

Scottish Parliament

The bill also bans agency workers’ wages from being any more than 150% higher than those of equivalent permanent staff.

In addition, it aims to improve transparency by introducing new reporting responsibilities.

Every financial year health and social care organisations will be required to show Scottish minsters how they have complied with the law.

Minsters must then report this information back to parliament and set out what action they will be taking to address any issues that have emerged.

Scottish ministers will also be required to show parliament how they have taken “all reasonable steps” to ensure the country has a “sufficient” supply of registered staff including nurses.

They must take into account variations in staffing needs in different geographical areas of Scotland such as rural or island communities, stipulates the legislation.

Work is still needed to develop guidance and secondary legislation to sit alongside the bill before it can be implemented.

Family nurse partnership

Family nurse scheme to be in place in ‘all parts’ of Scotland

Welsh flag

Welsh flag

Your guide to pioneering staffing legislation in Wales 

Wales made history in 2016 when it became the first country in Europe to introduce legislation around safe staffing.

After receiving royal assent in March 2016, the Nurse Staffing Levels (Wales) Act was passed before being fully implemented in April 2018.

Under the law, health boards and NHS trusts have a legal duty to ensure there are enough nurses to provide “sensitive” patient care in all settings.

In addition, it states that in adult acute medical and surgical inpatient wards, a specific nurse staffing level must be calculated, and reasonable steps should be taken to maintain it.

For these two settings, the Welsh government issued statutory guidance in November 2017 which laid out the steps NHS organisations must take to calculate and maintain staffing under the act.

According to both the law and the guidance, a “designated person” at each local health board or NHS trust- who must be a registered nurse or midwife- should calculate nurse staffing levels based on professional judgement, an evidence-based workforce planning tool, and consideration of how far patients are sensitive to nursing care.

Whilst the law does not mention specific ratios, it states that the person deemed responsible for calculating the nurse staffing level, must take into account an average ratio of nurses to patients which is “appropriate to provide care to patients that meets all reasonable requirements”.

Welsh assembly

586 Welsh assembly

Welsh Assembly

One of the requirements of the act is that health boards have to monitor and keep a record of the extent to which nurse staffing levels have been maintained and the impact that not maintaining them has had on patient care.

A year on from when the law was fully implemented, the Welsh government are expecting health boards to be reporting back to their own boards with an evaluation imminently.

The law also has a provision to extend to other service areas, and in May this year the Welsh government announced plans for the legislation to cover inpatient paediatric and district nurse led community services as a priority.

Chief nursing officer for Wales, Professor Jean White said that the government was in the process of developing workforce principles to enable health boards to review their current staffing arrangements and “set the groundwork” for the extended legislation.

Map of Wales