Item 6 is next, a debate on petition P-06-1276, 'Extend section 25B of the Nurse Staffing Levels Act (Wales) 2016'. I call on Buffy Williams to move the motion on behalf of the committee. 

Motion NDM8077 Jack Sargeant

To propose that the Senedd:

Notes the petition, ‘P-06-1276 Extend section 25B of the Nurse Staffing Levels Act (Wales) 2016’, which received 10,572 signatures.

Motion moved.

Diolch, Dirprwy Lywydd. On behalf of the Petitions Committee, I'm delighted to open the debate on petition P-06-1276, 'Extend section 25B of the Nurse Staffing Levels Act (Wales) 2016'. The text of the petition reads: 

'Nurses across Wales are short of 1,719 highly-skilled life-saving staff members. This means nursing staff give NHS Wales 34,284 extra hours every single week—and it still isn’t enough. Research shows that where there are fewer nurses, patients are 26% more likely to die overall rising to 29% following complicated hospital stays. The Welsh Government should extend Section 25B of the Nurse Staffing Levels (Wales) Act 2016 to give the Welsh public the full team of nurses they desperately need.'

Thank you to the Business Committee for agreeing our request to debate this petition, which has received 10,572 signatures. This petition is part of a broader campaign led by the Royal College of Nursing Wales. They argue that extending section 25B—the section of the Act that relates to the calculation of staffing levels in a range of settings—will save lives.

They point to the progress to date, since the Act was passed in 2016. Wales was the first country in Europe to protect patient care by placing nurse staffing levels into legislation. This was a groundbreaking achievement. By introducing the legislation, attention has been drawn to nursing, changed the behaviour of health boards, and made patients safer. Scotland has followed in Wales's footsteps with the introduction of the Health and Care (Staffing) (Scotland) Act 2019.

The settings covered by section 25B have already been extended. When the law was first passed, section 25B only applied to acute adult medical and surgical wards. On 1 October 2021, it was extended to children’s wards. Campaigners are now arguing that it should apply in all settings where nursing care is provided, starting with community nursing and mental health in-patient wards. I was not a Member when the legislation was introduced, but debate about how far and how fast minimum staffing levels could be extended was a big part of the Bill’s scrutiny journey. It remains a live issue.

In May 2022, RCN Wales published a report on implementation of the legislation. This found that the Nurse Staffing Levels (Wales) Act 2016 has improved patient care and increased the number of nursing staff on wards covered by section 25B. In the Welsh Government’s letter to the Petitions Committee, the Minister for Health and Social Services describes the premise of the petition's title as flawed and lacking in important legislative context. She also notes the global shortage of nursing staff and the ongoing work to develop more effective workforce planning.

In correspondence to the committee, the RCN argue that today’s debate will allow the Welsh Government an opportunity to outline a timescale for the extension and highlight any barriers and constraints they are currently facing. This would allow the public to have a better understanding of why an extension of section 25B has not yet been possible. I look forward to hearing the arguments on all sides.

Thank you, Buffy, for opening this debate. I would like to begin by saying that the Welsh Conservatives wholeheartedly support the extension of section 25B of the Nurse Staffing Levels (Wales) Act 2016 to include community nursing and mental health in-patient settings. We support this extension because it is clear to us that the situation nurses find themselves in is both unacceptable and, in the long term, completely unsustainable for the profession.

Every week, nurses give the Welsh NHS an additional 67,780 hours, equivalent to an extra 1,807 nurses. This essentially means that nurses are being systematically overworked by health boards who are ultimately cutting corners by not employing enough nurses for patient care. Long term, this is detrimental to the mental and physical health of nurses, which then creates a higher risk of patient care being compromised, and has a huge knock-on effect on the family life of nurses as they spend more and more time away from their family, working longer and longer shifts. It creates a negative impression that nursing is a poor career choice.

I was honestly shocked by the number of cases at Welsh health boards where understaffing has led to deep concerns about patient safety, and has even led to injury and death—from a shortage of midwives in Cwm Taf Morgannwg University Health Board's maternity services, where an independent review found that a third of stillbirths could have been prevented with proper care and treatment, to shortages in Betsi Cadwaladr University Health Board's vascular and emergency services, where the Royal College of Surgeons found that there were immediate operational pressures due to consultant availability and nurse staffing within the health board. It is clear that severe staffing pressures are ongoing and are leading to serious deficiencies in care.

Turning to mental health, the Ockenden report into Tawel Fan found that some patients had experienced a loss of dignity, being left in urine-soaked sheets or found wandering the ward unsupervised. Similarly, the Holden report into the Hergest unit in north Wales found that inadequate staffing meant that the needs of patients in the unit were not met, and this resulted in patient dignity and safety being compromised. The Welsh Conservative group's own research has highlighted unsafe staffing levels in Wales's accident and emergency units, and it is clear that the Welsh NHS workforce is continuing to face burnout after several years of the pandemic, alongside increasing waiting lists and pressures in emergency care. I, like many others, believe that the Welsh Government should provide more support in this area, and focus efforts to increase student places, and ultimately support the larger NHS workforce.

As the Minister will know, Wales is the only nation of the UK that does not publish national statistics for nursing vacancies in Wales, leaving many to believe that there is something to hide. But Members will be interested to know that figures given to me by the Royal College of Nursing Cymru, show that there were 2,900 nursing vacancies in 2021-22, costing the Welsh NHS £133.4 million in emergency nursing—an increase of 41 per cent from the previous financial year. And, as my colleague, Buffy Williams has also mentioned, the RCN found that there were an additional 144 full-time equivalent nurses and 597 full-time healthcare support workers on section 25B wards in November 2020, compared to March 2018, which was before section 25B came into force. This shows that extending the section 25B on nurse staffing levels will have a major positive impact. I think all Members here will agree with me that failing to extend section 25B is highly unacceptable. And I therefore urge all Members here to support the motion. Thank you. 

Before I move on, there is a slight noise in the Chamber, which I've asked ICT to look at. Are Members content to continue, or are they being distracted? Yes? Okay. Well, we'll see if we can get that resolved, hopefully. We'll continue. Rhun ap Iorwerth. 

Thank you for the opportunity to speak in this debate, and I'd like to thank the petitioners, of course, for gathering the names in order to draw attention again to the critical situation that we are facing, in terms of the number of vacancies and the need to extend the legislation on safe nursing levels within our health service. And I will repeat that word: 'safe'. This is about patient safety. Someone from your family maybe—you yourself, perhaps. To quote from petition itself, if there are fewer nurses than there should be,

'patients are 26 per cent more likely to die'.

This is about safety. And, of course, the legislative framework for ensuring safe staffing levels is to be seen in the Nurse Staffing Levels (Wales) Act 2016. Extending that is what we're calling for again today. Yes, requiring the Act to reach all parts of the NHS back in 2016 was asking a lot in practical terms. Well, given that we are in 2022, it's time to extend it further—to extend section 25B.

Experiences of the pandemic, of course, only reinforced what we already know about the NHS and the nursing workforce—one that was suffering from staff shortages, low pay, low morale, one that operated in an environment deprived of investment and resources. It's no wonder that one of the biggest challenges we have is the sustainability of the nursing workforce. There are far more nurses leaving the NHS than can be matched by newly qualified nurses or internationally recruited nurses. And regrettably, there's been far too little action by Welsh Government since RCN’s last report in 2019 to address nursing retention issues.

It's up to Welsh Government to lead, to take the lead, on nursing retention through a national retention strategy. RCN Wales have published a retention paper that sets out what's being done elsewhere in the UK and what could be done in Wales. Instead, it seems Welsh Government would rather stick its head in the sand when it comes to the scale of the problem. There are no published national statistics provided by Welsh Government for nursing vacancies. Well, we've tried to help with that; the petition we have in front of us mentions 1,700 vacancies. I was recently given a figure of over 400 vacancies in one health board. So, seeing that, I knew that 1,700 sounded too low, so we conducted our own fresh research in parallel. So did the Royal College of Nursing, and we both came to the same result: approaching 3,000 nursing vacancies in Wales. It's a frightening figure, but the RCN's wider research tells us more: figures earlier this year showed that more than half of Wales's nurses are demoralised due to a staffing crisis. Seventy-eight per cent of nurses felt that patient care was being compromised. These are issues that are not going away; they need to be addressed right now.

In the past, the health Minister has commented that section 25B is based on evidence; being grounded in evidence is what gives the Act its credibility, but even though the evidence points clearly to the need to ensure patient safety through safe staffing, she is reluctant to act, still. Just look at the findings of the Tawel Fan report in September 2014; that surely demonstrates the horrific impact on patient care that results when lack of funding, lack of sufficient staff, lack of skills in the workforce, lack of leadership all combine, and the resulting issue isn't addressed. In June 2021, 16 organisations wrote to the First Minister to urge the Government to ensure safe nurse staffing and expand section 25B of the Nurse Staffing Levels (Wales) Act 2016 to mental health in-patient wards and community settings. But still, we wait. When will the Welsh Government commit to valuing our nursing workforce in this way?

I understand that the chief nursing officer has written to Health Education and Improvement Wales regarding the all-Wales nurse staffing programme, and indicated that she is not going to publish the principles for mental health or health visiting. Now, that doesn't bode well. It would mean that the work for those workstreams are unlikely to move forward. Can I ask, does the Minister intend to publish the principles for mental health and health visiting, and if not, why not? We know that staffing levels that are too low endanger the well-being—the lives, even—of patients. We know that it exacerbates low morale in the workforce, leading to a loss of experienced, valued staff. We cannot wait any longer. Can we please see a Labour Government willing to do what's right for the nursing workforce and for patients? And again, I thank the petitioners.

We should all be concerned about the possibility of nearly 1,800 vacancies across Wales, because there's no doubt that a shortage of nurses will compromise nursing care; it's inevitable. Buffy Williams has told us that it has led to a change of behaviour by health boards, and I hope, therefore, an improvement and a greater focus on ensuring that staffing levels are up to complement in acute medical and surgical wards, because that's obviously where the most acutely ill patients normally are, and therefore, the ones whose lives can be saved by better nursing.

But I suppose what I want to understand is whether the recent extension to children's wards in October last year has been successful in ensuring that we have a full complement of staff nurses in children's wards, because at the end of the day, this is all about recruitment and retention of nurses, and if we're simply begging Peter to pay Paul, we're not actually resolving the problem. If we want to extend it to community nursing and mental health settings, which sounds ideal, do these nurses actually exist out there, and if not, why not? So, I want to look at the recruitment and retention issues that all health boards are facing, and that's partly because if you're employed as a member of staff as a nurse, there isn't the flexibility that somebody who's also got caring responsibility needs to ensure that they can be only signing up for the work for which they are available, rather than what the NHS wants them to do.

If you've got small children, you are simply not going to be able to drop things overnight, work overnight, work different days when you don't have childcare; it's not possible. And so, that's one of the reasons that main scale nurses are driven into agency working. In the last financial year, 2021-22, NHS Wales spent £133 million on agency nursing, which was a 41 per cent increase on the previous financial year. Now, that would pay for the salaries of nearly 5,000 newly qualified nurses, so there's something wrong going on here, and it would be useful to hear the Minister's view on this, because agency offers better pay compared with the equivalent NHS staff pay. And that is what is leading to the bizarre situation of agency nurses travelling from London or Manchester to fill vacancies at the Heath or at Ysbyty Gwynedd.

So, I understand why the new all-Wales agency framework contract signed last year for 2021-24 is capping the hourly rates to nursing agencies, otherwise, you simply make the problem worse. But if you rely on agency nursing, you're not only spending more money that you could be spending on a permanent workforce, but you are in danger of being in a very dangerous situation where we simply don't have enough staff, and that the ones who are still working for the NHS then become completely exhausted so that they then take early retirement or go and get another job. So, this is a really important issue and, therefore, we should very much thank the petitioners for this.

I think one of the things that we could learn from is the importance of prudent healthcare and whether we are using effectively multidisciplinary teams, headed by highly qualified nurses, but with less well-qualified other people working beneath them to do some of the important caring jobs that I know are done by auxiliary nurses or by breastfeeding advisers, all depending on which setting they're working in. It seems to me that that is one solution for preventing a possible meltdown in the way that we provide nursing care, both in the community and in our hospitals.

I was compelled, really, to contribute to this Petitions Committee report after two visits. The first was to Glangwili General Hospital in my constituency over the summer recess, where I met with staff in what was a very real, very raw and very honest discussion with staff around the levels that they're seeing in terms of nursing levels. We're quite right to talk about nurses leaving the profession, but those who are staying are staying over fear of letting their colleagues down, which I think is really quite heart-wrenching to hear from those on the front line within our hospital services. They're at the end of their tether.

The second visit was with the Royal College of Nursing yesterday, where I got figures for my own health board of Hywel Dda. Hywel Dda agency nurse spend for 2021-22 was £28.9 million, and the registered nurse vacancy rate in 2021-22 was 539.2—approximately 20 per cent—which is the highest in Wales. These are incredible statistics, and they just show why we, as Welsh Conservatives, why we on this side of the Chamber stand in solidarity on this and back extension of 25B wholeheartedly. I think we really need to assess what we are doing to support our nurses, because they are the backbone of our healthcare system, be that in general hospitals, be that in GP practices, where nurse practitioners are developing a larger strategic role. I think it's vitally important that we do all that we can to support them.

I call on the Minister for Health and Social Services, Eluned Morgan.

Thank you very much. I welcome this debate today, and I thank Members for their comments.

As Minister for Health and Social Services, I, of course, appreciate the challenges faced daily by our NHS workforce. We've come through a challenging pandemic, largely due to the incredible efforts of our front-line workers, not least the nursing staff, and we will forever be grateful to them for that.

Now, I'm under no illusion that the pandemic is not over and we don't know what surprises still lie in store for us. The fact is that its residual impacts are generating real pressure across the system. The bleak economic forecasts in the coming winter and beyond will have a compounding effect on that. 

Ensuring we have the right workforce skill mix across our health and care system to provide appropriate, holistic, individualised care to the people of Wales is therefore of fundamental importance and on that point I'm sure we all agree. But I'm afraid I'm unable to agree with this petition's assertion that extending section 25B of the Nurse Staffing Levels (Wales) Act is in and of itself going to achieve that. Firstly, the Act requires that an evidence-based workforce planning tool is a necessary component for considering application of section 25B to any particular care situation, and such tools do not currently exist for other situations. So, we're not saying 'never', we're just saying 'not at the moment'. [Interruption.] And any call to apply—if you'd let me finish the sentence, thank you—any call to apply section 25B of the Act across new clinical settings simply ignores that fact. And the fact, for example, when you look at mental health wards, is that they involve more complex care, so they have multidisciplinary teams, so they're more complicated. So, you can't just take what happens on one ward and put it and project it onto another ward. So, we do have to understand that different circumstances require those planning tools to be effective. 

Thank you, Minister, for taking the intervention. In terms of workforce planning, we've heard that the vacancy rate is just under 3,000, but that figure comes from the Royal College of Nursing, and opposition parties here have done their own research to get to that figure. But in Scotland, England and Northern Ireland the Government publishes those figures, and I wonder if you would be minded to do that, because that in itself, I would hope, would be helpful in highlighting the issues and helping to address the workforce issues.

Thanks very much. Well, I have asked HEIW to do some work on this, so I'll come on to that in a second, if you don't mind.

The second point that I think is really important to understand is, even if those tools were available for every nursing situation, it's simply inaccurate to suggest that extending section 25B to all of those areas would result in giving Wales 'the full team of nurses', as the petition puts it, and that's simply because, at the moment, those nurses don't exist. So, the nursing staff shortage is an issue that's being experienced globally; it's not just a Welsh issue. The World Health Organization has estimated that nursing and midwifery vacancies currently represent more than 50 per cent of the global shortage of health workers. Now, we know that there are significant registered nursing vacancies already in our health boards and across our care sectors, and this is not an issue that would be directly addressed by any extension to section 25B of the Nurse Staffing Levels (Wales) Act.

Now, we're already doing a huge amount to recruit and to train nurses. The number of commissioned training places has increased by 69 per cent to 2,396 since 2016, so that would take us a long way towards those 3,000 that you have identified. But we need to recognise that the problem is retention, and that's why I have asked HEIW to do more work on retention specifically of nursing staff. I'm delighted that, on Friday, I'll be going to Aberystwyth to open the new centre where we will be training more nurses in Wales, and I think it's really important that we understand also—. And I recognise that we're spending too much money now on agency nurses, so I've asked again for some work to be done on that. How do we bring the cost of agency nurses down? It's not straightforward. If you give our current nurses more money, then the agency staffing costs will go up and we've still got gaps. So, none of it is straightforward, but I've asked some key people to help, come up with some ideas for how we can—

[Inaudible.]—I'd appreciate it if you'd just let me make a short intervention just on agency nurses, if that's possible.

Well, we have had a couple of interventions.

It's just on the matter of agency—

That's a 'no', Darren. Thank you.

Oh, pardon me. Okay. You asked for ideas; I was going to give you one.

Thank you. Well, not while I'm standing on my feet in the middle of a debate. So, I have asked for ideas from the professionals who are helping me with this.

Now, it appears that what those who have signed the petition are saying is that they want the right number of nurses and healthcare staff in the system to meet the care needs of the people of Wales, and that's my aspiration too. But a legislative pledge that cannot be delivered won't secure that, and I can't commit the Welsh Government to that approach. Rather, the steps that will help to ensure that are planning and workforce modelling in an effective way, effective strategies for recruitment and retention of staff, including programmes that are standardised to provide clinical oversight and tutoring to our nursing staff, and also international recruitment. Health Education and Improvement Wales is leading on the development of a sustainable national workforce development plan for nursing, and I hope that this work will lead to solutions and a focus to tackle the fundamental challenges in terms of the workforce. Thank you.

I call on Buffy Williams to reply to the debate.

Firstly, I'd like to thank the petitioners for bringing this petition forward, and I'd also like to thank the Members who've contributed today and the Minister for her reply. Nurses make up around 40 per cent of NHS Wales employees; they are the heart and soul of our national health service. What has been clear in this debate is that, whatever party we belong to and whatever community we represent, we all want to ensure that we have the appropriate number of nurses to ensure the safety and well-being of patients. But how we achieve that, particularly in the face of a global shortage of nurses, is the key challenge. I'd like to thank members of the Royal College of Nursing for attending today's debate; I look forward to seeing them in the Neuadd later this evening to mark the launch of their new report.

I hope today's debate has shed further light on the progress made over the last few years and the challenges that remain, and I know that this is an issue that will continue to be debated long into the future. Diolch.

The proposal is to note the petition. Does any Member object? No. The motion is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.