Points of clarification requested by the Health & Social Care Committee in respect of the written evidence provided by the Minister for Health and Social Services.



Paragraph 7: The existing tools and levers that the Welsh Government has deployed already go some way to satisfying the aims of the Bill, and could be further strengthened, for example by mandating the use of the acuity tool once it has been fully validated. Could you clarify how this would be mandated?




The Minister could use his powers of direction as set out in the National Health Service (Wales) Act 2006 section 12, to direct a Local Health Board to use the Adult Acuity Tool.  The Local Health Boards would then be under a statutory duty to comply with these directions and would not be free to use their own discretion to decide whether or not to follow these. 






Paragraph 43: The CNO’s principles are an interim measure to be used until the acuity and dependency tool can be fully implemented and do not mandate a staffing ratio. Could you clarify that what the word ‘mandated’ means in this context given that paragraph 2 of the Welsh Government’s Adult Acute Nursing Acuity & Dependency Tool Governance Framework (May 2014) states that ‘in April 2012 CNO presented the Nurse Staffing Principles Guidance to the Chief Executive Forum, after which the Guidance was issued with an expectation that each Trust/Health Board would work towards implementation of the Principles in all adult acute in-patient wards’?




The word ‘mandate’ in paragraph 43 is not being used in the context of the governance arrangements for utilising the adult acuity tool; here the term is used to highlight the fact that the ratio is a recommended starting consideration and is not a compulsory requirement in itself.


While the CNO & Nurse Director principles include the principle of a ratio of 1:7 nurse to patients, this is only a guiding figure to assist local considerations of nurse staffing levels. Locally, the triangulated methodology will be used to assess staffing needs on an ongoing basis, utilising an evidence based tool (once fully validated), professional judgement and nurse sensitive indicators jointly to make that assessment.