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Health and Care (Staffing) (Scotland) Act



The Act sets out requirements for safe staffing across health and care services and health and care professions.

The Act was almost three years in the making - first announced at RCN Congress in 2016 in Glasgow, by the then First Minister of Scotland, Nicola Sturgeon MSP and passed into law in 2019.

RCN members and staff in Scotland worked hard to influence and shape the legislation for the benefit of patients, care service users and our members. Campaigning by RCN members, staff and the public across Scotland resulted in an Act that meets over 85% of the RCN’s asks.

What does the Act do?

Safe staffing

The Act has two important overarching provisions and sets out how they should be applied.

The principle that the main purpose of staffing is to provide safe, high-quality services and the best outcomes for service users. 
A duty on NHS and social care providers to make sure that, at all times, there are suitably qualified and competent staff working in the right numbers. 

Applying the principles

The Act sets out how these overarching principles should be applied across health and social care, including in the commissioning of services.

The Act also specifies different duties for health boards, councils, integration authorities and the Scottish government to report publicly on compliance with the Act.

Duties on NHS boards

NHS Scotland Health Boards

In the Act there are several duties on NHS boards.

Use the ‘common staffing method’ in all areas where there are workforce and workload planning tools set out in legislation. This means the approved tools are used alongside other considerations – such as vacancies, skills mix, patient need, clinical advice and staff feedback – to set establishments and inform any service design. 
Have in place ways of identifying, assessing and escalating real-time risks to care, arising because of staffing issues, and to ensure staff are aware of these, and relevant staff have appropriate training and time and resources to implement them. Also have in place ways to address severe and recurrent risks in the board. 

Seek and have regard to clinical advice in making staffing decisions, to record their decisions and explain where this conflicts with clinical advice and to have a procedure for those involved in the risk process to record disagreements with decisions and request reviews. 

Establish a procedure for individuals with lead clinical professional responsibility (i.e., the Director of Nursing and Medical Director) to provide a compliance report quarterly. 


Ensure lead clinical professionals have the time to do their jobs properly. 

Give time and resources to staff for relevant training. Encourage and support staff to give views about staffing and to tell staff about decisions made. 

Limit the amount an NHS board can pay to agency staff without reporting to Scottish Government. 

Send annual reports on how the legislation is working to Scottish Government, and for the government to then report to the Scottish parliament. 

Duties on Scottish government

Scottish Government

As for NHS boards, in the Act there are several duties on the Scottish government. 

‘Take all reasonable steps’ to ensure registered nursing supply and make an annual report to the Scottish parliament on this. 

Consult with the appropriate professional bodies and trade unions when writing guidance to the legislation. 

Add new tools, or remove old ones, from the legislation and/or to amend the common staffing method. 

Scottish government ministers

Scottish Parliament at Holyrood

Duties on Scottish government ministers in the Act

Give an annual report to the Scottish Parliament about the operation of the legislation. 

Take this report into account in determining supply of registered nurses and other registered professionals. 

Consult with relevant professional bodies and trade unions when preparing guidance on the legislation. 

Duties on Healthcare Improvement Scotland (HIS)

Healthcare Improvement Scotland

Healthcare improvement Scotland (HIS), the national healthcare improvement organisation for our country, is also required to do certain things in law under the Act.

Monitor how the legislation is working in boards. 

Review the common staffing method, in consultation with relevant trade unions and professional bodies and make recommendations for changes to government. 

Maintain workforce and workload tools, and develop new ones, in consultation with relevant trade unions and professional bodies. 

Recommend changes to government. 

Duties on social care

Social Care

Social care providers are included in the Act and have a duty to provide appropriate training for their staff, including suitable assistance to gain relevant qualifications. 

The Act also includes other powers to be acted upon. 

For the Care Inspectorate to develop and maintain staffing methods for care homes for adults (in the first instance), in collaboration with relevant trade unions and professional bodies. 

For Scottish Ministers to require the use of tools, or to end such a requirement where the tool is no longer appropriate. 

For the Care Inspectorate to carry out reviews of the operation of the legislation and report to Ministers.

Page last updated - 12/02/2024