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Safer staffing should be enshrined in law, says RCN

Secretary of state should be ‘accountable’ for this

Jo Carlowe

Wednesday, 01 May 2019

Safer staffing within the NHS should be enshrined in law.

This is the message from the Royal College of Nursing (RCN), which, in its submission to the Health and Social Care Select Committee’s enquiry into the NHS Long-term Plan: legislative proposals, is calling for the secretary of state for health and social care to be made accountable to Parliament for safe staffing.


In written evidence to the Health and Social Care Select Committee’s enquiry, Dame Donna Kinnair, RCN’s chief executive, stated: “Successive secretaries of state have taken decisions which mean we cannot deliver the long-term plan. The lack of accountability on staffing has put us back years, so there needs to be an explicit accountability for the workforce with the secretary of state.

“There is no delivery of the long-term plan without investment in the workforce.  We cannot go on thinking we can have the same number of nurses and just move them around and feel we can deliver a safe, quality NHS. This is why we need a commitment for accountability.

“We are talking about accountability to Parliament for the workforce of our biggest treasure, the NHS."

In its evidence, the RCN reiterated its call for explicit accountability for ensuring a sufficient number of staff across health and care to be enshrined in law.  

The RCN’s evidence also stressed that the government’s drive to move more care from acute A&E hospitals into the community will be impossible without substantially more nursing staff.

Integrated Care Providers should only be formed if it can be demonstrated that there will not be an adverse effect on the pay, terms and conditions of any staff involved, or on patient care and safety, the RCN stated.

Dame Donna said: “To create an integrated health and care system that operates on evidence rather than political calculation, opportunities for data collection and reporting must be enhanced, and not diminished, through any structural changes to NHS provision.”

The RCN is calling for organisations throughout the system to be given specific duties and legal powers related to the workforce, and to be held accountable for the decisions they take.  Specifically:

  • The secretary of state for health and social care to be accountable to Parliament for making sure there are enough health and care staff, with the right skills, in the right place, at the right time to care for patients, based on population needs. 
  • NHS England and NHS Improvement and other national organisations including Health Education England (HEE) to be given powers to develop and grow the health and care workforce, including responsibilities for workforce planning and supporting the system to implement them.
  • Providers of publicly funded health and care services should be accountable for demonstrating their corporate accountability for decisions about workforce planning to deliver safe and effective services, underpinned by evidence.

NHS England and NHS Improvements have proposed changes to the way in which services are procured within the NHS, to be replaced by a “best value test”.  In its response, the RCN has asked for: further assurance that this test will not have adverse effects on the workforce; that any new approach won’t lead to increased likelihood of the cheapest provider being selected on the basis of cost alone; and that contracts will not now be awarded to those who do not have experience of managing clinical risk.

A Department of Health and Social Care spokesperson said: “Our Long Term Plan sets out how we will make the NHS the safest healthcare system in the world and ensure it is a consistently great place to work for our dedicated staff.

"There are 16,900 more nurses on our wards since January 2010, with 52,000 more in training and we are improving retention by promoting flexibility, wellbeing and helping more nurses return to practice. 


As well as providing funding to increase university training places, the NHS will soon set out its Workforce Implementation Plan to ensure the NHS has the staff it needs for the future.”

Oral evidence to the Health and Social Care Committee is ongoing. 

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