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Safe and Effective Care

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

Last Shift Survey Report

This year's survey reveals the extent of the UK staffing crisis in nursing, with 8 in 10 shifts lacking enough staff to keep patients safe. Read more today.

Looking for the #ForTheFullTeam petition?

The #ForTheFullTeam petition ended on 12 May with a phenomenal 10,572 signatures. This means the Petitions Committee will consider referring it for a Welsh Parliament debate. We are calling on the Welsh Government to extend health boards' legal obligation to calculate and maintain nurse staffing levels that precisely reflect patient need, starting with inpatient mental health and community nursing.

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

  • It's a law that protects nurse staffing levels in Wales. It was passed on 21 March 2016.
  • It means health boards and NHS trusts in Wales must "have regard to the importance of providing" appropriate numbers of nurses in all settings.
  • The requirements go further in adult acute medical and surgical settings and, as of October 2021, in children's wards.
  • In those areas, 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.

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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.

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.

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 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 - 31/05/2022