Ensure staffing levels are safe
Regulation 18 of the Care Quality Commission (CQC), the body that regulates all health and social care services in England, states that providers should ‘deploy enough suitably qualified, competent and experienced staff to enable them to meet all other regulatory requirements described in this part of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014’.
To meet the regulation, providers must provide ‘sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service’. The approach providers use to determine the number of staff and skills mix required must reflect current legislation and guidance, and must be continuously reviewed and adapted where needed.
The regulation also states that staff must receive the support, training, professional development, supervision, induction and appraisals that are necessary for them to carry out their role and responsibilities. They should be supported to obtain further qualifications and provide evidence, where required, to the appropriate regulator to show that they meet the professional standards needed to continue to practise.
This regulation is one of CQC’s fundamental standards. While the CQC cannot prosecute for a breach of this regulation or any of its parts, they can take regulatory action.
Under the Health & Care (Staffing) (Scotland) Act 2019, NHS Scotland boards will be legally required to be appropriately staffed.
The timeline for implementation has now been set out, with all provisions of the Act to come into force in April 2024.
NHS Wales Health and Care Standard 7.1 (Workforce) states that ‘health services should ensure there are enough staff with the right knowledge and skills available at the right time to meet need’.
The Quality Standards for Health and Social Care are used by the regulating authority in Northern Ireland (the RQIA – The Regulation and Quality Improvement Authority) to assess the quality of care provided by the health service. On staffing, the standards state that the care provider should:
- have sound human resource policies and systems in place to ensure appropriate workforce planning, skill mix, recruitment, induction, training and development opportunities for staff to undertake the roles and responsibilities required by their job, including compliance with departmental policy and guidance, professional and other codes of practice, and employment legislation
- have a workforce strategy in place, as appropriate, that ensures clarity about structure, function, roles and responsibilities and ensures workforce development to meet current and future service needs in line with Departmental policy and the availability of resources
- have systems to promote a healthier, safer, and “family friendly” workforce by providing advice, training, support and, as appropriate, services to support staff
Design safe rotas
To create safe rotas, employers should:
- Use forward-rotating rota designs (day-evening-night)
- Minimise shift patterns and rota changes that cause sleep disruption
- Allow for adequate recovery time between shifts (>11 hours)
- Provide built-in rest breaks while on duty that comply with rest/break entitlements
- Monitor the extent of repeat interruptions to provide patient care/advice while on call
- Avoid long weekly working hours (<60 hours) and work shifts (<10 hours)
- Minimise requirements to take annual leave only at times that are fixed in the rota
Create safe working conditions
The following BMA guides set out practical actions employers should take to improve facilities, reduce fatigue, and create safe and healthy work places.
- Mental Wellbeing Charter and the Mental Wellbeing Checklist
- Junior doctor wellbeing checklist
- Fatigue and Facilities Charters for England, Wales and Northern Ireland
- Fatigue and sleep deprivation guidance
- Preventing and reducing violence against staff
These actions include:
- Appropriately dealing with, and taking proper actions to prevent, violence and abuse against staff
- Providing clean, modern and fully equipped facilities with proper rest and sleep amenities
- Developing and implementing a wellbeing strategy, including appointing ‘Wellbeing Guardians’ at board level
- Making support services accessible
- Providing sufficient parking (that staff are not charged for) and access to nutritious food options
- Encourage staff to raise concerns about their working patterns and fatigue
- Ensure adherence to all contractual requirements for working hours, safeguards and rest/recovery
Comply with legislation
There is strong evidence linking patient safety, patient experiences and the quality of care with the safety, health and wellbeing of the workforce.
Your employer also has a legal duty to protect the health and safety of staff as detailed in relevant regulation and legislation.
The main pieces of legislation that employers must comply with are:
- Health and Safety at Work etc. Act 1974 or equivalent
- Management of Health and Safety at Work Regulations 1999 or equivalent
- Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) or equivalent
- The Working Time Regulations 1998 and Working Time (Amendment) Regulations 2003 or equivalent
Amongst other things, employers have a legal duty to:
- Ensure all staff have comprehensive access to accredited, competent, comprehensive and confidential occupational health services
- Have an incident reporting procedure, with systems in place to ensure appropriate records are kept
- Have effective arrangements in place to manage violence and aggression risks
- Have effective arrangements in place to manage risks related to work-related stress
- Manage the risks to staff from being bullied or harassed by patients, other staff or their managers
- Have effective arrangements in place to ensure the organisation and its employees comply with the legislation on working time
For more information see the NHS Staff Council's Health, Safety and Wellbeing Partnership Group (HSWPG) have developed a set of workplace health and safety standards which pull together legal requirements and guidance to help organisations comply with 'goal setting' legislation.
Employers should refer to these standards for more information on the full remit of their legal duties to protect staff from injury and illness.