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Letter to NHS Chief Executives in England

12 January 2022

Dear Chief Executive,

The Royal College of Nursing (RCN) recognises the continuing, extremes of demand and capacity which our health and care system is experiencing because of the pandemic. We acknowledge with gratitude the unwavering commitment given to all aspects of patient care by all staff.

However, I write to inform you that RCN members are contacting us with accounts of working in extraordinary circumstances, under extreme pressure, with nurse-to-patient ratios that are challenging and frequently compromising to patient safety, and to our members’ professional values. They are worried about their ability to deliver safe and effective care for their patients.  They are raising concerns of disciplinary action if something was to go wrong, and are concerned that the impact of the circumstances, resources, information and guidance available to make decisions in such an extraordinarily pressured context may not be adequately acknowledged in potential investigations. 

As the professional regulatory body, the Nursing and Midwifery Council has been clear throughout this pandemic that professionals, in partnership with patients and people they provide care for, are to use their professional judgement to assess risk and make sure people receive skilled care, informed by the values and principles set out in professional standards. They have also been clear that it is the responsibility of the organisations in which our members work to ensure that they are supported to do this. 

The setting of staffing levels and nurse-to-patient ratios are outwith the control of an individual nurse working at the point of care. The RCN continues to advise our members to document concerns, raise them through organisational policies to resolve the issues locally where possible. 

We expect every organisation to adhere to their legal duty under The Health and Safety at Work etc Act 1974 (GB) and/or The Health and Safety at Work (Northern Ireland) Order 1978, together with the Regulations which fall under either Act, towards all employees and others affected by their work activities, by taking all reasonable and practicable measures to reduce the risk of harm to staff, patients and the wider public as far as possible.

In particular, Regulation 3 of the Management of Health and Safety at Work Regulations (MHSR) 1999 and the Management of Health and Safety Regulations (Northern Ireland) 2000 require employers to identify significant risks, by carrying out their own suitable and sufficient risk assessments. The measures to reduce risk, should then be implemented in line with the general principles of prevention as set out in schedule 1 to the Regulations. In addition, Regulation 5 requires all employers to have appropriate and effective arrangements in place to effectively manage their preventative and protective measures, specific to their organisation.

These are exceptional times, and colleagues are working in exceptional circumstances with extraordinary pressures. The RCN recognises that most employers are taking their statutory duties as an employer very seriously, especially in relation to the health safety and wellbeing of our members. However, I write to request that nonetheless you take immediate steps to reassure your registered nurse and nursing associate workforce that they will not be held individually or professionally accountable for any omission of patient care which can be attributed to issues outwith their control, such as, inadequate staffing levels, skill mix, or low levels of experience in the relevant area of practice. 

I ask that by reassuring staff of this you help to confirm to them that you value the contribution that our members are making day in and day out and will not leave them professionally vulnerable in anyway.

Yours sincerely

Pat Cullen, General Secretary & Chief Executive 


Page last updated - 06/04/2022