Consultation on proposed safe staffing laws for nursing and midwifery: independent analysis of responses

Chapter 4 - Future approach and priorities

The consultation paper sets out that the proposed new requirements would:

• Apply to organisations providing health and social care services, including but not limited to NHS Boards, Local Authorities and all organisations providing services regulated by the Care Inspectorate. It would also apply to organisations providing services on behalf of Integration Joint Boards.
• Be applicable only in settings and for staff groups where a nationally agreed framework, methodology and tools exist.

Requirements would apply at an organisational level and would not apply to individuals providing services.

Question 11 - Do you agree with our proposal to consider extending the requirement to apply nursing and midwifery workload and workforce planning approach to other settings and/or staff groups in the future?

11a - If yes, which staff groups/multi-disciplinary teams should be considered?

11b - If yes, which other clinical areas/settings should be considered?

Table 19: Question 11 – Responses by type of respondent.

Type of respondent	Yes	No	Not answered	Total
Individuals	66	9	1	76
Organisations:
Health & Social Care Partnership	2	3		5
Independent sector health or social care organisation	2			2
NHS based professional group or committee	4	1		5
NHS Body or Board	5		1	6
Other			3	3
Other public body			2	2
Professional college, body, group or union	7	1	4	12
Total organisations	20	5	10	35
All respondents	86	14	11	111
% of all respondents	77%	13%	10%	100%
% of those answering the question	86%	14%		100%

A majority of those answering the question, 86%, agreed with the proposal to consider extending the requirement to apply nursing and midwifery workload and workforce planning approach to other settings and/or staff groups in the future. The majority of both individual and organisational respondents agreed (66 out of 75 respondents and 20 out of 25 respondents respectively). However, a majority of Health and Social Care Partnership respondents disagreed.

Table 20: Question 11 – Discussion Groups

Yes	No	Mixed Views	Not answered	Total
22	1		2	25

Twenty-two of the discussion groups agreed, one disagreed and two did not answer the question.

There were 98 further comments made through Citizen Space at 11a. and 75 comments made at 11b, although a number of these simply referred back to their previous comment. All of the discussion groups made a comment across 11a. and 11b. Many of the comments made did not distinguish between the two specific aspects covered under the sub-questions ( i.e. which teams and which clinical settings should be covered), and hence a single analysis of all comments made is presented below.

The three most frequently-raised themes across Questions 11a and 11b were:

• A whole-systems, multi-disciplinary approach is required, rather than having a focus on particular professions or specialties.
• In terms of particular staff groups, all AHPs and medical staff were the most frequently-suggested.
• In terms of the clinical areas or settings respondents felt should be considered, the suggestions were again many and varied but the most frequently-identified was nursing and care homes.

As noted above, in addition to or instead of commenting on specific staff groups or settings, a number of respondents made general comments at this question.

These general comments tended to cover one of two broader issues. The first of these tended to be raised by organisational respondents and was that a whole-systems, multi-disciplinary approach is required, rather than having a focus on particular professions or specialties. A small number of these respondents identified problems they felt could result from not taking a whole-systems approach. These included that, within the landscape of integrated services, a legislative requirement covering one profession could result in that group being protected against budget-related staffing decisions. However, this could lead to significant reductions in numbers in 'unprotected' professional groups. Some of those raising this concern, including two Health and Social Care Partnership respondents, suggested that Health and Social Care Partnerships should be allowed time to develop integrated services and then to consider the staffing required.

The other main concern was raised by a smaller number of organisational respondents and was that that the approach overall, and specific tools being used, must be tested and established as being fit-for-purpose, including within a multi-agency, multi-professional context. It was also noted that using the same set of tools with different staff groups may not work and that approaches which work within a medical model will not necessarily be suited to other services.

Finally, in terms of more general comments, and reflecting comments made at earlier questions (and at Question 3 in particular), a Public body respondent suggested that extending the approach to the care sector would replicate or confuse existing approaches.

In terms of which teams or settings should be covered, there were references to 'all', 'all areas', 'all health and social care settings', 'all clinical settings', 'all multi-disciplinary teams', 'all essential staff' etc, but the precise intentions of each respondent were not always clear. The analysis below focuses on the more specific references made.

Staff groups or teams

In terms of particular staff groups which respondents felt should be considered, the two most frequently-identified groups were:

• All AHPs. This was the most frequently-made suggestion and was made by a number of discussion groups and individual respondents, as well as across the range of organisational respondents.
• Medical staff. This was also a frequently-made suggestion across the discussion groups and individual respondents.

Many of the other suggestions made were for staff groups which fall into one of these wider definitions and included:

AHPs: Diagnostic or Therapeutic Radiographers; Dieticians; Occupational Therapists ( OTs); Physiotherapists; Practice Development Nurses; Prosthetists, Orthotists and Orthoptists; Speech and Language Therapists.

Medical staff: GPs; Junior Doctors; and Paediatricians.

Nursing staff: Advanced Nurse Practitioners; Clinical Nurse Specialists; Community Psychiatric Nurses; Infection Control Nurses; and Practice Nurses.

Support staff: Administrative staff (with the majority of references suggesting this referred to NHS-based staff); Other facilities or ancillary staff, including porters or domestics.

Clinical or clinical support roles: Healthcare Support Workers; Laboratory staff; Pathologists; and Phlebotomists.

Social work or care roles: Social workers; and Social care staff, including homecare staff.

Other groups identified included: Clinical academic and research staff and healthcare scientists; Dentists; Psychologists and psychotherapists; and Pharmacists or clinical pharmacists.

Clinical areas or settings

In terms of the clinical areas or settings respondents felt should be considered, the suggestions were again many and varied. The suggestions tended to be raised at discussion groups or made by individual respondents, with the most frequently-identified settings being:

• Nursing and care homes.
• Outpatient departments.
• Home-based services, including Care at Home or Hospital at Home. Also, social care services, including homecare.
• Community-based services.
• Out of hours services.
• GP practices.
• Prisons.
• Mental health services, including community-based, Children's and Adolescent Mental Health Services and Forensic Mental Health Services.
• Community hospitals.
• All settings that provide healthcare, including health centres.

There were also smaller numbers of references to a broad range of other settings including: Operating Theatres and Surgical Departments; Day hospitals; Primary Care Emergency Centres; Contracted services such as nursing agencies; Hospices; Pharmacies; Laboratory services; Telehealth and Telecare services; School nursing services; Addictions services; Clinical Psychology and counselling services; all private health or care settings; Stepdown and intermediate care and rehabilitation services; Liaison teams; Integrated community teams; Social work services; Residential Children's Homes; Supported accommodation; Day Centres; and the Scottish Ambulance Service.