Kirsty Williams AM


David Rees AM,

Chair, Health and Social Care Committee,

National Assembly for Wales

Pierhead Street


CF99 1NA

National Assembly for Wales

Pierhead Street


CF99 1NA


Tel: 0300 200 7277

 26 June 2015


Dear Chair,


Safe Nurse Staffing Levels (Wales) Bill


Thank you again for your Committee’s robust and insightful May 2015 report on the Safe Nurse Staffing Levels (Wales) Bill.


In your report, you recommended that I undertake further analysis of the potential costs increases in expenditure on agency/bank nursing staff that could occur in the short term, as a consequence of the Bill’s implementation. This is attached as an annexe to this correspondence.


Following your recommendation, I wrote to the Minister on 22 May 2015, requesting a copy of the most up to date versions of submitted three-year-plans for Local Health Boards, from 2015-16 to 2017-18.  I anticipated that these would include the financial requirements of the Local Health Boards’ plans over three years, including estimates of bank and agency nursing costs. I anticipated that this would then enable me to determine whether these plans- if implemented- would meet the requirements of the Bill, or whether additional expenditure would be required.


On 1 June, the Minister advised that the three year-plans for local health boards, from 2015/16-2017/18 would not be available for this purpose. The Minister did indicate that his officials would be able to provide “indicative data which would be of assistance… in calculating an estimate of the relevant costs.”


While awaiting this indicative information, I wrote to the Minister on 9 June to clarify whether officials would be able to indicate, as part of this indicative data, whether any of the three year plans did not include meeting the existing CNO guidelines on staffing levels and any references to or estimates of the use of bank and agency staff going forward. I noted that an early draft three year plan for Cardiff University Health Board made specific reference to reviewing “the Nursing establishments to ensure adherence to Chief Nursing Officer staff staffing principles.”[1]


On 20 June, the Minister provided in correspondence some indicative information, and links to a limited number of draft Integrated Medium Term Plans which had already been in the public domain. However, this information unfortunately did not include the requested clarification on projected bank and agency staffing costs.


In his 20 June correspondence, the Minister cautioned me that while “one or two of the individual plans make reference to the Chief Nursing Officer’s Principles, this is not a requirement of the plan.” However, in the same document he also stated that “going forward it is expected that LHBs will use the triangulated approach to set nurse staffing levels.”[2]


The officials who supported me in originally developing the Safe Nurse Staffing Levels (Wales) Bill team have produced the following analysis using the information provided by the Minister, information already in the public domain, and information gathered from meetings with:

·         Dr Aled Jones, Cardiff University (one of the authors of the recent report ‘Research into nurse staffing levels in Wales)

·         Charlette Middlemiss, NHS Wales Shared Services Partnership - Shared Services.


It has taken some time to compile this analysis, and I apologise for any impact that this may have had on the Committee’s timetable. I understand that you will be requesting an extension from the Business Committee for conducting Stage 2 proceedings on the Bill, and am grateful for you doing such. Should it be appropriate by the end of Stage 2 proceedings, my intention would be to use this analysis to produce an updated Explanatory Memorandum.


I have sent a copy of this correspondence to the Minister for his awareness.


Yours sincerely,


Kirsty Williams

Assembly Member for Brecon and Radnorshire






[1]  Cardiff and Vale University Health Board, Draft Integrated Medium Term Plan 2015/16- 2017/18, page 32, considered at Vale of Glamorgan Council, Voluntary Sector Joint Liaison Committee, 23 March 2015, accessible at:

[2] Minister for Health and Social Services, 20 June 2015.