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Staffing for Safe and Effective Care

Implementing and extending the Nurse Staffing Levels (Wales) Act 2016

  What is the Nurse Staffing Levels (Wales) Act 2016?

  • The Nurse Staffing Levels (Wales) Act 2016 became law on 21st March 2016.
  • Health Boards now have a legal duty to have regard to the importance of providing appropriate numbers of nurses in all settings.
  • In adult acute medical and surgical settings and, as of October 2021, in children's wards, nurse staffing levels must be calculated according to a specified methodology - and maintained at that level.
  • Health boards have a duty to report on compliance with staffing requirements and to take action if failings occur.
  • The Welsh Government has issued guidance on how to determine appropriate staffing levels.

  Why is this so important?

  • This law protects patients. Research shows poor nurse staffing levels increased mortality by up to 26% compared to better staffed wards.
  • This historic Welsh law is the first of its kind in the UK. International precedents have been successful in reducing patient mortality.
  • It empowers the ward sister/charge nurse and the Nurse Director equally to ensure that there are safe nurse staffing levels.
  • Safe staffing reduces readmissions, health care-associated infections, medication errors, falls and pressure ulcers as well as allowing nursing staff time to deliver compassionate, sensitive care.

Latest report: Progress and Challenge in Delivering Safe and Effective Care 2022

This new report examines how health boards have implemented the Nurse Staffing Levels (Wales) Act 2016, and in particular Section 25B. Based on publicly available documents, after taking a look at national themes and indicating the challenges ahead, the report looks in depth in each health board.

  • The Nurse Staffing Levels (Wales) Act 2016 has improved patient care and increased the number of nursing staff on wards covered by Section 25B.
  • Patient acuity has increased, meaning Wales needs more registered nurses and health care support workers to care for patients.
  • All health boards were prepared for the extension of Section 25B of the Nurse Staffing Levels Act to paediatric inpatient wards on 1 October 2021.
  • The biggest challenge is that there are far more nurses leaving the NHS than can be matched by newly qualified nurses or internationally recruited nurses.

It follows RCN Wales’ 2019 report, Progress and Challenge: The Implementation of the Nurse Staffing Levels (Wales) Act 2016.

Progress and Challenge Click the image to read the report or read the Welsh edition.

Help us give Wales the full nursing team we deserve

Nursing staff in Wales are short of 1719 team members. We are calling on the Welsh Government to extend safe nurse staffing legislation to include inpatient mental health and community nursing for safe and effective nursing for all.

Ward Managers: The Importance of Being Supernumerary

We're excited to launch our new report and short film on ward managers in Wales: the issues they currently face, but also the impact great leadership brings in improving patient care and reducing adverse incidents.

Often responsible for around 30 patients and teams of around 40, ward managers need protected time when they aren't required to care directly for patients and can focus on managing and leading their teams. This is called being supernumerary, and it benefits both staff and patients.

RCN members made this possible. Over 100 ward managers from across NHS Wales participated in three focus groups, interviews and an online survey. Their views and experiences and views formed the basis of our recommendations. Read the report.

Sign the petition for staffing levels in Wales

Nurses across Wales are short of 1,719 staff members. Patients are suffering and the profession needs you to take action now. Add your voice to this petition. #SafeStaffingSavesLives

Implementing the Nurse Staffing Levels (Wales) Act 2016:
Capturing the journey from legislation to implementation

Read our new ebook exploring what actions made the difference in delivering the Nurse Staffing Levels (Wales) Act 2016.

The passing of the Nurse Staffing Levels (Wales) Act 2016, the first of its kind in Europe, stands as a testament to the ability of the organisation to campaign effectively, to engage in political and legislative processes with evidence, and to support both the introduction and passage of key legislation to set minimum nurse numbers in acute hospital settings.

Become an e-Campaigner

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Find us on Facebook, Twitter and Instagram for all the latest news, events and consultations.

Safe and Effective Care everywhere

RCN Wales is campaigning to protect patient care everywhere by extending section 25B of the Nurse Staffing Levels (Wales) Act 2016

The Act’s provisions now need to be extended to other areas including mental health, community and care homes. Further work is needed to ensure that better patient and staffing information in these fields is held and that workforce planning tools are developed.

Campaign with us: download digital campaigning materials here to use on social media!

Read our latest reports:

Learning Disability nursing (English/Welsh)
Ventilation in hospitals (English/Welsh)
Care Home nursing (English/Welsh)
RCN Wales 2020 member survey (English/Welsh)

Male HCSW with patient

Support for members

We're here to help

  • Find out what to do if you see poor care or feel you are being prevented from providing safe, compassionate care here.
  • If you are an RCN activist, please login to the reps hub to see the RCN Wales Safe Staffing toolkit. It has been designed by our Employment Relations Team to provide tips and resources that can help both yourselves and our members to escalate any concerns around the implementation of the Safe Staffing Act within their organisations.


Safe Staffing - History of the Campaign in Wales

The Nurse Staffing Levels (Wales) Act 2016 became law on 21st March 2016

  • RCN Members campaigned hard, from 2006, for the Act we gained in 2016.
  • Discover the story behind the campaign: watch the film, An Act of Compassion, or read its companion book authored by Greg Lewis. Find out the journey RCN members undertook, from first identifying the issue of insufficient nursing numbers, to the present, that sees us working closely with the Welsh Government to extend the scope of the Act to cover other areas of nursing care.
  • Find out more about the history of the legislation here: Nurse Staffing Levels (Wales) Act 2016 
  • In November 2019 RCN Wales published a report in which we looked at the progress on implementing the new law. We reported successes but also identified areas of challenge. Read Progress and Challenge: The Implementation of the Nurse Staffing Levels (Wales) Act 2016  in English or Welsh.
  • Richard Jones Safe Staffing

    Safe and Effective Care - What is happening around the UK?

    Take a look at what is happening in England, Scotland and Northern Ireland here.

    Page last updated - 10/05/2022