National Assembly for Wales / Cynulliad Cenedlaethol Cymru
Health and Social Care Committee / Y Pwyllgor Iechyd a Gofal Cymdeithasol

Safe Nurse Staffing Levels (Wales) Bill / Bil Lefelau Diogel Staff Nyrsio (Cymru)

Evidence from Macmillan Cancer Support – SNSL(Org) 10 / Tystiolaeth gan Cymorth Canser Macmillan – SNSL(Org) 10

Committee Clerk

Health and Social Care Committee

National Assembly for Wales

Ty Hywel

Cardiff Bay

CF99 1NA

19 January 2015

Dear Committee Clerk

Consultation on the Safe Nurse Staffing Levels (Wales) Bill

I am writing in response to the Consultation on safe nurse staffing levels (Wales) Bill.  We wrote to Kirsty Williams AM in September 2014, welcoming the recognition of the need for safe nurse staffing levels throughout Wales. This is of paramount importance to people affected by cancer not least as we know that the majority of these will be cared for on non cancer specialist wards.  

By 2030, it is estimated that the number of people living with or beyond cancer in Wales will nearly double to a quarter of a million (from 130,000 in 2015 to 250,000 in 2030, around 8% of the population).  As the nature of cancer changes, so do the needs of people who are affected by it, and the range of health and social care professionals and services required to help meet those needs. This growing and ageing population often with multiple co-morbidities will have significant implications for health and social care and will challenge existing models of cancer care. 

People who decades ago would have died shortly after diagnosis will increasingly survive for longer. 1 in 4 people will be living with the consequences of treatment and disease and many will be living with an incurable cancer, remission and relapse. Nurses are in a prime position to ensure that care is holistic, addressing clinical and non clinical needs within the multidisciplinary team. There is evidence that nurse staffing levels have a significant impact on patient care and based on the numbers above, people affected by cancer will have an unprecedented need for safe and compassionate nursing care in future years. Nurses also play a crucial role in the provision of effective cancer information, care co-ordination, the promotion of co-production and supporting self management.

There is overwhelming evidence from the results of the first Wales Cancer Patient Experience survey, published in January 2014, which shows that having a Clinical Nurse Specialist enhances the delivery of cohesive care and provides an overall positive experience for patients and their family throughout and beyond their treatment.  Nursing was by far the largest staff area for which comments were made by respondents. 

Whilst the experience of nursing care was characterised broadly as positive, there were some areas of concern around general nursing and comments often reflected concerns about nursing workloads and staffing levels.  In particular, when patients responded to the question - In your opinion, were there enough nurses on duty to care for you in hospital?  only 60% of patients said there were always or nearly always enough nurses on duty to care for them in hospital; 29% said that there were sometimes enough on duty and a further 11% said there were rarely or never enough on duty. 

Patient comments around nursing staff levels and availability collected from the Wales Cancer Patient Experience survey include observations such as the following:

“I always felt the nurses were under pressure and therefore time allocated to patients was limited which often leads to limited information at times.  The Day Unit staff appeared to be rushed off their feel”

“During the period I was there I saw the rules of the ward go out of bathroom window.  Whilst I was there someone fell to the floor.  He pulled the red cord with no response.  In the end he sat on a stool, dragged himself to the door and called for help.  He waited more than ten minutes”

“I think the nursing staff do a very good job, but there should be more of them.  Sometimes they are very stretched to give the right care and treatment needed.

Nurses and other staff, most of them excellent but severely overworked”

“More nurses as they couldn’t take me to the toilet and wait with me as I was having dizzy spells due to low blood pressure.  They left me on toilet, only to come back and find me on floor with bloody gash in my head”

“The nursing staff on the wards work very hard, but are very overworked.  Staffing levels need to be improved”.

Legislating around safe staff nursing levels will go a long way to alleviate these pressures and we believe that the principles of providing safe nurse staffing levels will enhance the provision of holistic care and delivering ‘person-centred cancer care’ outlined within the Welsh Government’s Cancer Delivery Plan. We support the move towards putting in place mechanisms for safe nurse staffing levels and we would expect to see robust monitoring around the implementation and learning from the challenges and opportunities to be shared throughout Wales to help reduce variation.

Debates and forums such as the Royal College of Nursing event held on 30 September 2014 have highlighted the international evidence to support this legislation and the benefits achieved around patient outcomes and increased job satisfaction within the nursing community. That said, this model has not been piloted in Wales, and we would expect its application to be cautiously applied to our healthcare system, taking into consideration detailed analysis around budgetary implications and the potential legal consequences for Health Boards and individuals with responsibility for overseeing its delivery. 

Evaluation should also take into consideration safe nurse staffing levels in all settings which are not initially covered within the legislation eg community nursing, nursing homes and in the private sector.  It is crucial that safe nurse staffing levels are implemented consistently throughout Wales and are flexible enough to respond to local demand, the requirements of each different acute and specialist service, the skill mix available and the ability to react to the complexity and dependence level of individual patients' needs.

If you would like further information from us regarding the findings of the Wales Cancer Patient Experience survey in relation to nursing levels, please do not hesitate to get in touch with me at XXXXXXXXXXXXXXXXXor phone me on XXXXXXXXXXXXX.

Yours sincerely

Lowri Griffiths                                                     

Policy and Public Affairs Manager, Wales