The NHS’s greatest asset is its staff. They go above and beyond on a daily basis to ensure that patients across the length and breadth of Wales are seen by the right people, in the right place, at the right time. However, there are often simply not enough staff available at any one time to ensure the quality of care that all healthcare professionals strive to provide.
In 2016 Welsh Government introduced the Nurse Staffing Levels (Wales) Act, placing a general duty on all health boards to make sure there were enough nurses to care for patients sensitively in all areas they provide or commission services. The Act also places a specific duty on health boards to calculate and maintain the nurse staffing level for adult acute medical inpatient wards and adult acute surgical inpatient wards. Since then, Welsh Government has extended that duty further to include paediatric inpatient wards from April 2021.
Studies have shown that poor nurse staffing levels increase mortality rates by up to 26% compared to better staffed wards. Research has proven safe and effective nurse staffing levels reduce readmissions, healthcare associated infection rates, medication errors, falls and pressure ulcers. With nurses in the wards that currently benefit from reliable staffing levels more able to deliver their expert knowledge and compassionate care to patients in a safe environment, why should patients receiving care in other healthcare settings continue to be left at a disadvantage?
This is why RCN Wales is continuing its campaign for safe nurse staffing levels everywhere, focusing on extending Section 25B of the 2016 Act to even more health care settings - from mental health inpatient wards to community nursing, to make sure that anyone under the care of a nurse is in the safest possible environment. We support them in their fight. As doctors, we’re fully aware that safe and appropriate staffing numbers across different settings leads to better patient wellbeing and more support for healthcare staff. In fact every 10% increase in the number of degree educated nurses within a hospital is associated with a 7% decline in patient mortality. You can’t ignore these figures.
However, patients and their families would be right to expect there to be safe levels of all types of staff, not just nurses, across all health boards in Wales. It is for this reason that we are calling for Welsh Government to go further. Inspired by this ground-breaking legislation, it is crucial that action is now taken to ensure safe staffing levels are in place for doctors as well.
The safety of our patients depends on staff working within a safe system. Due to the recruitment and retention crisis we are facing in the Welsh NHS, we are continuing to hear from doctors on the ground that they don’t feel the system is safe, with fears that the health of their patients is being put at risk. Nine out of ten doctors say one of the main reasons for making errors is pressure or lack of capacity in the workplace, and three quarters agree that staffing levels have been slowly worsening. Time and time again doctors are reporting that rota gaps are causing havoc in our hospitals, severely impacting the delivery of care and adding to a system already under immense pressure.
What is more, these pressures mean that many staff tell us that, due to the extra work they are needing to carry out, they are unable to complete all the regular ongoing training that is required and the extra strain on the system compounds the reported psychological effect often seen in doctors of ‘moral injury’ or being forced to make decisions against the best interests of a quality service. When doctors who genuinely want to help people are forced in to these positions is it any wonder we’re in the midst of a recruitment and retention crisis?
Our members continue to tell us how they are responsible for multiple pagers for departments throughout a hospital. This means that they are often the sole doctor responsible for four or five wards – covering different types of specialties – at any one time. This is unsafe for patients and their doctors and there is a clear link between the staffing levels at a hospital and the quality of the care provided to patients.
Understaffed hospitals have been a strain on our health service for too long. Doctors, like nurses, regularly take on extra shifts to help plug the gaps but the legislation we’re proposing would enshrine safe staffing in law, for the benefit of staff as well as patients. Every patient deserves high quality care and every member of healthcare staff deserves to work in a safe environment. Introducing safe staffing legislation for all professions – but with an initial focus on nursing, midwifery and medicine – will ensure that patients receive the quality care that the Welsh Government aspires to deliver. It will also ensure that staff and patients are able to work and recuperate in a safe ward.
Last year Welsh Government has the perfect opportunity to take this step.
Their Quality and Engagement (Wales) Act, while well intentioned and welcomed by us had a fundamental element missing: a clause on safe staffing. Let us be absolutely clear: you cannot provide a quality service without the right staff. After all, quality and staffing are intrinsically linked. While Welsh Government said they were not against the idea of safe staffing, they added at the time that it would be “inappropriate” to include safe staffing in the Quality and Engagement Act as there as not enough time to give it the full consideration needed.
Wales led the way with the Nurse Staffing Levels (Wales) Act 2016, but we’re now in danger of lagging behind other parts of the UK unless we take steps to extend the Act across more healthcare settings and bring medical professionals within the same remit. Over the next Senedd, there simply needs to be for a duty on NHS bodies to ensure appropriate staffing and to have real-time staffing assessments in place to make sure wards are always manned with the right number of staff who are able to deliver the highest possible quality of care.
We look forward to Welsh Government making good on their 2019 commitment to ensure that safe staffing across the whole of the Welsh NHS can be made law.
Notes to editors
Article originally published in The National on Monday 5 April 2021