National Assembly for Wales / Cynulliad Cenedlaethol Cymru

Health and Social Care Committee / Y Pwyllgor Iechyd a Gofal Cymdeithasol

Safe Nurse Staffing Levels (Wales) Bill / Bil Lefelau Diogel Staff Nyrsio (Cymru)

Evidence from Abertawe Bro Morgannwg University Health Board - SNSL AI 14 / Tystiolaeth gan Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg - SNSL AI 14


Additional Information for Health & Social Care Committee - Safer Staffing Levels regarding Health Board Commissioned care- ABM University Health Board


The Health Board only commissions beds within the independent sector for those individuals eligible for Continuing NHS Healthcare: Continuing NHS Care placements in nursing homes


Commissioning involves a set of activities by which services are planned and organised to best meet the health needs of service users. 


Within the Health Board the process involves assessment of need, consultation with the provider, their agreement that they are able to meet the needs of the patient and monitoring of the service provision as outlined under the 2014 CHC Framework guidance.


However for those placed in nursing home beds commissioned by the Local Authority, the Health Board contributes towards the cost via the Funded Nursing care process. Funded nursing care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the provision of nursing care by a registered nurse for individuals assessed as requiring nursing care. 


The responsibility for the accommodation and social care costs are the responsibility of either the Local Authority (LA) and/or the individual.  Contracts with providers are arranged by the LAs.


Care & Social Services in Wales (CSSIW) or the Care Quality Commission (CQC) reports for out of county providers provide information in respect of dignity of care and regulatory compliance based on the standards.


Staffing Levels

While the Chief Nursing Officer for Wales has given direction on safe staffing levels within acute care hospital wards there is currently no such clarity on staffing numbers to patient ratio within the independent sector.


In relation to staffing levels the regulator within Wales – CSSIW, under the Care Home Regulations 2002 require the provider (taking account of the size of the care home, the statement of purpose and the number and needs of service users) to:-

(a)ensure that at all times suitably qualified, competent, skilled and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users;

(b)ensure that at all times a suitably qualified registered nurse is working at the care home.


Currently there is no one Continuing NHS Healthcare Contract across Wales, however this is currently being worked on at a Welsh Government level. Within ABMU we have a variation in contracts which all adhere to the CSSIW requirements, but do not currently stipulate safe staffing levels.


The focus is rather on quality assurance and the monitoring of the contract is based on this premise. A standard review template is used which is based on the National Minimum Standards for Care Homes for Older People and the Fundamentals of Care issued by the Welsh Government.



The Health Board depends upon nurse assessors to report any issues relating to patient safety or quality of care whilst they undertake individual care management reviews within commissioned care homes. 


In addition the commissioning areas obtain assurances regarding patient safety through the reviewing of CSSIW/ CQC reports and also liaising with Local Authority commissioners. 


Joint contract monitoring reviews are also undertaken by the Localities and LA.  These are undertaken on an annual basis.  All joint monitoring includes the review of both Continuing Healthcare and Funded Nursing Care providers.  Nurse assessors would undertake the reviews on behalf of the Health Board, whilst a contract monitoring officer would undertake the reviews for the Local Authority.


In light of the Older Person’s Commissioners report and Operation Jasmine outcomes, there is a need to ensure that the independent commissioned sector is considered when improvements are being driven for healthcare which is the aim of this bill. However should this sector be included as part of the Bill, there is a need to consider the Funded Nursing Care element, the accountability of the Local Authority, and independent providers.