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Landmark safe staffing law now in force for nurses in Scotland

All Scottish health and care settings must ensure enough qualified nurses, midwives and medical professionals are available to provide high-quality and safe care
Three nurses at a very busy hospital workstation

All Scottish health and care settings must ensure enough qualified nurses, midwives and medical professionals are available to provide high-quality and safe care

Three nurses at a very busy hospital workstation
Picture: John Houlihan

A ‘groundbreaking’ safe staffing law that requires the government to ensure there are enough nurses available for employers to provide safe care has finally come into force in Scotland.

The Health and Care (Staffing) (Scotland) Act 2019 was passed in June 2019, but was paused by the Scottish Government during the COVID-19 pandemic.

Safe staffing law is first legislation of its kind in the UK

From 1 April, all health and care settings in Scotland have a legal duty to ensure enough qualified nurses, midwives, doctors, paramedics and many other healthcare professionals are available to provide safe and high-quality healthcare.

It also imposes a duty on the Scottish Government to ensure there are sufficient numbers of registered nurses, midwives and medical professionals available to enable employers to meet their duty to ensure safe staffing.

‘Legislation will help put in place systems and processes to allow real-time assessments of staffing levels, meaning resources can be managed more easily, and that people can get the right care, at the right time, in the right place’

Neil Gray, cabinet secretary for NHS recovery, health and social care, Scotland

It is the first legislation of its kind in the UK, setting out legal requirements for multidisciplinary safe staffing across all NHS and care settings, including services run by the NHS, local authorities, charities, agencies and the independent sector.

‘Today is a significant day for health and social care in Scotland. This new act will ensure services are more effective, efficient and sustainable,’ said Neil Gray, cabinet secretary for NHS recovery, health and social care.

‘It will help put in place systems and processes to allow real-time assessments of staffing levels, meaning resources can be managed more easily, and that people can get the right care, at the right time, in the right place. The act will also help to embed a culture of openness, so workers are informed about decisions relating to staffing and feel able to raise any concerns.’

New law requires employers to identify risks relating to safe staffing in real time

The act also requires employers to report to ministers on the use of ‘high-cost’ agency staff; ensure staff are qualified, competent and receive appropriate training; identify risks relating to staffing in real time; and give adequate time for team leaders to fulfil their responsibilities.

Organisations will then be obliged to make annual reports to the government on how they have carried out their duties in following the act. Ministers will then collate and present this information to parliament and use it to inform improvements to staff policy.

RCN Scotland’s director Colin Poolman welcomed the new law, but warned that nursing vacancies remain stubbornly high. He said: ‘RCN members were instrumental in shaping this groundbreaking legislation and in securing a timetable for the act to be implemented.

‘Today marks an important milestone, but implementation must be accompanied by investment, innovation and continued scrutiny if we are to retain existing nursing staff and establish a sustainable nursing workforce for the future.’

No safe staffing legislation for healthcare professionals in England or Northern Ireland

In Wales, the Nurse Staffing Levels (Wales) Act 2016 was introduced almost eight years ago, which requires health boards to ‘take reasonable steps’ to maintain nurse staffing levels in a number of NHS settings. However, it only applies to a limited number of settings, excluding community and mental health.

Currently, there is no legalisation regarding safe staffing for healthcare professionals in England or Northern Ireland.

London South Bank University’s healthcare and workforce modelling chair Alison Leary said: ‘Statutory obligations to provide safe staffing are important.

‘They are not a workforce model, but they should act as a safety rail, a minimum requirement with staffing levels set locally in line with professional judgement, good modelling for labour and patient and staff safety – the same as any other safety critical industry.’

Nurses' input needed for research into Scottish safe staffing legislation

Researchers will be looking at the early impact of the Health and Care (Staffing) (Scotland) Act 2019 coming into effect by surveying nurses in Scotland in collaboration with Eileen Lake, a professor of nursing from the University of Pennsylvania, and the RCN.

Edinburgh Napier University lecturer in nursing Azwa Shamsuddin said: ‘The RCN will reach out to its Scottish members from 1 May with a survey link to ascertain a baseline to the staffing situation in Scotland in the very early stages of the legislation being enacted. Nurses and nursing support workers in Scotland will be able to respond to this survey that runs throughout May and will be encouraged to share the survey link with their colleagues.

‘We firmly believe this to be an important study that can inform policy into the future to the benefit of nurses, patients and the wider public.’


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