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Bill-046 - Kirsty Williams - Minimum Nurse Staffing Levels Bill

Pre-ballot Information

A Member must provide ‘pre-ballot information’ to set out the intended purpose of their proposed Bill before it is entered into the Presiding Officer's ballot. This information is set out below.

Policy Objectives of the Bill

This legislation would require the government to produce regulations which set a minimum staffing level for nurses in Wales. These regulations would be required to set minimum nurse staffing levels for each different acute and specialist service. I am also mindful to include a requirement for the regulations to address the complexity of patients’ needs and on the skills mix in a hospital.

The legislation would also give the government the power to issue similar regulations for community nursing, but only when they considered that sufficient evidence exists to support regulations in this area.

There is increasing evidence from across the world that having more nurses per patient substantially improves the care received by patients in the NHS. Most recently, the Francis Report, which looked at failings in the care provided by the Mid Staffordshire NHS Trust and cited long-term low staffing levels as one reason which contributed to poor treatment (vol. 1, p. 396, para. 3).

Nurses who have fewer patients to tend to are able to spend a greater amount of time with each patient and as a result can provide better care. If they are more easily able to identify potential problems with a patients care, then they are able to play a preventative, rather than simply reactive, role and consequently reduce the need for a patients treatment and the cost of this care to the NHS.

As demonstrated in the table below, Wales lags behind the rest of the UK in two key indicators of nurse staffing levels.


ScotlandEnglandWalesN IrelandAll nurses
Mean patients per nurse8.88.510.57.28.8
RNs as a percentage of staff6059566660
N-number of nurses180543150125998

(External Source Data: Royal College of Nursing Guidance on safe nurse staffing levels in the UK – Table 5:2 Patient:nurse ratios (all shifts) and skill mix on NHS ward by country) (PDF, 1.70MB)

Similar legislation has been introduced in California, New South Wales and Victoria (Australia) where it has improved nurse staffing levels and patient care. Studies in California have shown that minimum levels are effective in increasing staffing levels and in reducing mortality rates. Emerging evidence from Australia suggests that this is true there as well.

Support received

In 2011, the Royal College of Nursing Congress overwhelmingly supported the idea of legally enforceable staffing levels to improve patient care.


I have already consulted with the Royal College of Nursing and would consult with other healthcare groups if this entry is successful.

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